1170 NE 100 St (8)Sign
Dat
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
11 Baas D 1c o LID ()1
Legal Description IV �• ,.� Historically Designated: Yes No /
V
O w n e r / L e s s e e / Tenant SG" cl y / 4 \ Master Permit # t "I r D
Phone 3 os' ?S7 1 QY3
/ 7 4 - 4 1c z i , F (
Phone 3 6c 5
State # Municipal # Competency # ! 72 00 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION IlV�'.�+ As phki Pr; Vet tt y
Job Address
Owner's Address 1170 NI l0O S'S`
Contracting Co. /fir -v.004 AS LW
1 l4& pi,((
Qualifier
Square Ft.
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 layvs 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 do
construction and zoning. Furthermore, I authorize the : bove -named contracto . • • • . ork stated.
•
FEES: PERMIT
APPROVED:
Zoning
Mechanical
of owner an or Condo President
60 ,
RADON
Building
1q7 T9 1/7 Ave- Address
- d►
Date
Date
C.C.F.
,")\
Tax Folio
Estimated Cost (value)
ture of Contractor or Own
as to Contractor or Owner - Builder
My Commission Expires:
SHAWN O'TOOLE
MY COMMISSION # DD 026739
EXPIRES: July 10, 2005
r gr
F oi f . ,� Bonded Thru Budget Notary Services
NOTARY ' BOND
OND --
Plumbing Structural Engineer
compliance th all applicable laws regulating
ider
Date
Date
A ` COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY
A ��
WHEREAS, !'/!4A SG,
(owner)
following described property:
- Tax Folio #: ) ) 3 O< 0 1 9 Q y () C7
requests permission to install:
[sphalt, concrete, brick pavers
[ ] Landscaping
[ ] Other
within the public road right of way of
SIGNED, SEALED, EXECUTED AND ACKNO
SIGNED, SEALED AND DELIVERED in the presence of:
i' � /iavni Sliore� (/iC�ccc�e
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305).795 -2207
Fax: (305).756 - 8972
, hereinafter referred to as the Owner of the
Legal description /folio #:
Lot Block 1/1/ Subdivision rn S SQC,g
/ J 0 N i te r / 0 u SF
ORt664)f
l� PPS ,
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows:
I. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right
of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said
items within public right of way including restoration of street by reason of the Owner's failure to do so,
such expense shall be paid by the Owner or shall constitute a lien against the above described property
until paid.
2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from
any and all liability, which may rise by virtue of permitting the installation of these items within the public
right of way.
3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days
notice by the Village to do so. Failure to comply with this notice will result in the Village causing the
item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all
costs incurred in the removal and disposal of the item(s).
4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and
shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such
time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida
by the Village Manager of Miami Shores Village (or his fully authorized representative).
DGE on this 1 da of
owner
SHAWN OTOOLE
MY COMMISSION # DD 026739
EXPIRES: July 10, 2005
Bonded Thor Budget Notary Services
performed on
(1,
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant, S C , 7 A ktr.Mlr( , does hereby attest that the
(property owner)
attached survey, performed by C u t s Co C . ^; q, ` r 4 SS C G .
f name of surveyor's company)
is an accurate representation of the existing conditions and
(• .. a of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
Witness(sign and print)
SWORN TO AND SUBSCRIBED before me this AV day of • A 1I '10
Affiant is personally known to me, produced/ as identification.
SHAWN O'TOOLE
MY COMMISSION # DD 026739
EXPIRES: July 10, 2005
Bonded Thru Budget Notary Services