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PAINT PERMITr Owner of Building Architect Contractor or Builder Legal Description Address of Building D 'YN6 Lot /_ if BI CO TRACTO or BUILDER BUILDING MIAMI SHORES VILLAGE FLORIDA ELECTRICAL PLUMBING 0 PERMIT N_ 41154 ROOFING ❑ Work to be performed under this Permit V4-A- f Value of Project Date Contractor's License No. Ae/40 go. op Subdi- vision ry Sq. Ft. [�GGC� . [j II Amount of II Permit $ 19 This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether $own o , tlAe plans or drawings or in the statements or specifications and that be assumes respon- sibility for work done by his agents, servants or employe Signed • (INSPECTOR) BY lo consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 310197 Job Address izoz K. E . /Q / ` '' T ST2L;TT Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant SAM ` 4 /)A 2A P�q r e_rQ,4j Master Permit # f // S / ZOZ M C . (O ( Sf c p - mtiEr Phone (5 75 `i -6 3 (-,d Owner's Address Contracting Co. Qualifier State # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL Hat/66- MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION % /AT /NG !"7 2!/6E „ t1k /H )TE 1 Q-K , Ft 1 F/1eC Cary, Square Ft. Z 800 Estimated Cost (value) Z , 000 °o WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. • Signature of owner and/or Condo President 3117 Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT • ' RADON qD. APPROVED: Zoning Building Mechanical Plumbing 97 C.C.F. Address ;# Competency # address Address Address Phone Ins. Co. 31 Signature of Contractor or Owner- Builder Date Notary as to Contractor or Owner - Builder My Commission.Expires:. _ _ r • i)i/ Cy�3`,12 my lCkS" ..,: �`Cd •���. e ta \. LA.r /�S�n NOTARY ,0 BOND Electrical Date 3 /7 7 Engineering Date G Job Address /c 2 /0/ • Tax Folio, f5/ 7 9 ' Legal Description i Owner's Address IAA, A lJ E /0 / S% •• Phone �S4 - 63 �J Contracting Co. Address Qualifier i6WA SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one : BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION 444 Mi �.Gf,�/ �iLaD .s.GCI,� Square Ft._ WARNING SO MAY TO OBTA NOTICE Applicat on the a standard, Lessee PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY . (OWNER TO RETAIN COPY) / Tenant egrtlapyevj t to do work and installation as indicated above, and certify that all work will be performed to meet the in this jurisdiction. I understand that separate permits are __ for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify hat all the foregoing information is accurate and that all work will be do compliance with all40licable laws regulatin construction and zoning. Furthermore, I e the abo e-named co > > ,� 1 �, thA ed. • �'W'Ff 'My Commission Exp. April 30, 1996 to,/ . r 197545 Sign tpre ot 9 owner and/or Con Date: 66 J 0 rest Print typ or stamp name of Notary Publi Personally known DOR Produced I.D � Type and number d: N ary as to Owner and /o _'dent My Commission Expires: D ta ke an oath, or DID NOT take an oath. APPROVED: Z on i ng Estimated Cost(value) NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR Master Permit # ,9W /A 6d gnature of Contractor or Owner- Builder Date: Notary as to Contractor or Owner- Builder My Commission Expires: ** * * * * * *, * * * * * * * * * * ** FEES: PERMIT. /`50 RADON C.C.P. , 5 NOTARY L� j 0D TOTAL DUE 43 Fire Other Building ( Electrical Mechanical Plumbing Engineering Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address at / Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to e built on: Block / r.9 Lot Street and Number where work is to be done IY 0 y isia / 0 l tate 1,____voLit to be done and purpose of b ilding (by floors), state exterior colors .a• - _ — / L�.� and for no other purpose. Remodeling Addition Repairs ✓ No. of Stories Y New Building To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S APPLICATION FOR BUILDING PERMIT Subdivision 7 1 ) Amount of Permit 5 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned a s to employ only ss h subcontrac , on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA COUNTY OF DADE. } ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known. and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. Date Disapproved Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Cam . (submit samples) Read, Sworn to and Subscribed before me. Date - _ r 19 L No. /YG Y Street Ne /p/ a (6 V ,✓E / 7/ .Co/. 4; ti5 , > ? > 9,3.3/60 // of l OoS/ sd Notary Public, State of Florida Ob� My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.