121 NE 100 St (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7- 3- o O Job Address A' /� Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant A E Av,./
Owner's Address 7- " N
Contracting Co. Cr7 €eee c A j G ce;ie
Qualifier /7. e/!etih -V .
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING CHANICZO ROOFING PAVING FENCE SIGN
WORK DESCRIPTION i4 /03 /a e T
Square Ft. Estimated Cost (value)
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 Date Signature of Contractor or Owner- Builder Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires:
My Commission Expires:
g
FEES: PERMIT Zo HPa RADON C.C.F. b NOTARY 0 BOND
APPROVED:
Zoning
j v7 S7'
Mechanical � lJ (.C; lumbing
Master Permit # % t9 is
Phone(.3a 757 - 771✓r
Address 3/ f G/- /20" 715:3002_
ss# . Phon(3°33 22l -A5
TOTAL DUE
Building Electrical
Structural Engineer
0525/93 14:58 MSV 002
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7' I" Job Address 7 Tax Polio
Legal Description
Owner / Lessee / Tenant Master Permit IM
Owner's Address , "• /' / / ‘ 7.47 - 5- / 7-- Phone
Contracting Co. Address
Qualifier SSD - - Phone
State p Municipal if Competency 0 Ins.Co.
Architeet /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(aircle
one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAYING FENCE SIGN
WORK DESCRIPTION
Square Pt. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE POR IMPROVEMENTS TO YOUR PROPERTY (IP 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 ag 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, ROOPING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be don in aomplianc- with all applicable laws regulating construction and zoning. Furt ermore, I
out jise the abo " • aontrectdeto do the work stated.
igneture of owner a ` � ent Signature of
Date: 7 3 " Date: 7--
• • Condo Pre
Notary as
Mlr Comm,/
*e *
APPROVED:
E
COMMISSION # CC 930884
emgg o24, 2004
Bonded Thru Notary Public Underwriters
7. R R w
nt
PEES: PERMIT RADON
Zoning Building
�: ,.s ;� • MY COMMISSION # CC 930884
't . • EXPIRES: April 24 2004
'
' of • h ° Bonded 'film Notary Public Underwriters
Notary as to
My Commission
* * X
Owner - Builder
C.C.F.
Fire Other
NOTARY TOTAL DUE
Electrical
Mechanical Plumbing Engineering,
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans 4,1 specifications herewith submitted for the building or other structure herein
described. This application is made in compliance and conformity with the Building Ordinance o?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
/02 / tir /00 57 -
NE - 71/77-/-0,ri triewz
Registered Architect and /or Engineer
Name and address of licensed contractor
� '6�
- eeW 5(/G ‘) - / <Z.30 rScc� 4�5 - e/1/I—
33'2
Location and legal description of lot to be built on:
Lot �F7 Block 7 5
` Subdivision 61 `-- r 41 0 6 A, ° 2 o ift)
Street and Number where work is to be done /Z/,411-1 / DD 5/
State work to be done and purpose of building (by floors). state exterior colors (submit samples)
and for no other purpose.
New Building Remodeling Addition Repairs No of Stories /
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S Kf eODD Ov Amount of Permit S b 1
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 agree to employ only such subcontractors. on wo to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
}SS.
19
No. Street
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 a plication, and that he did sign the same. and that all facts therein by him stated are true.
Permit No. .. 7 r Date +/A/ v Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 825.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.