1280 NE 101 St (14)ger
Date 17 1( 0 - 94" Job Address 1 2 - • & D N 101
Legal Description ll 11
Owner / Lessee / Tena t CI OW Ct(GL- I v t & -? Master Permit # 3 7a )//
Owner's Address Oa V d I2 O N V i 0 I C o
Phone 7 TS 3
Contracting Co. t> ��J Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUI HANICAL ROOFING PAVING FENCE SIGN
1
WORK DESCRIPTION
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 /o
Date: FL-16-94
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
i r■ - 4 - hoo
President
C4 " 10 Qax Folio
Signature of Contractor o�
Date: l2,`I(o - 9y -
Notary as to Owner and /or Condo President Notary as to Contractor or Owner- Builder
My Commission Expires: My Commission Expires:
** * * * * * * * * * * * * * * * **
FEES: PERMIT 37
RADON C.C.F. / 49° NOTARY TOTAL DUE T✓'
Fire Other
Zoning Buildin �� 4 41, Electrical
Mechanical Plumbing Engineering
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ur tiro plans and specifications herewith submitted for the build
in or other structure herein described.' This application Is made in compliance and conformity with the Building Ordinance of !turns
Shores Village. Florida. and all provisions of the Laws of the State oI 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.
Date. .._..._...__... _ ,�� 19. aU
to '
N� '
Owner's lame and Address I 241) 1.....,..:. ._ No./.2 cf'" ?..�Street._ZO /S''
Registered Architect and /or Engineer
Name and address of licensed contractor ... t evn 4 1 ( ?. ! -1.1- - - 733°1 S.1.4. < yi /o:n'I) : 3'31d
Location and legal description of lot to be bu ji l 0 pp� aa ` �pp�
Lot Block ! . Subdivision. ... .il a. ✓1.—. — /".�z6z ..�/ 00/¢
Street and Number where work is to be done
State work to be done and purpose of building (by floors).. _. Ten io(L n i t NT.___..._
and for no other purpose.
New Building Remodeling Addition No. of Stories _
To be constructed of Kind of foundation oof�C
Estimated Total cost of improvements $ 3.t$ 7 Amount of Permit S 4 � 31
Zone cubage required Plan Cubage
Distance .to next nearest building Size of Building Lot
Maximum bee load to be borne by each floor
I hereby submit all the 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 obligations as an employer
of labor under the Florida Workmen's Compensation Act. being Section 59G6, 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 arc required by the Act. The undersigned agrees to employ only such subco on work t 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 ap-
peared
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 rr stated are true. ))
Penit No.. !k'!.:J..'/ Date ...11..._._._ Read. Sworn to and Subscribed before me.
I
Disapproved \ \� \ Date.
(Signed)
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Repairs
Notary Public, State of Florida
My Commiuion Expires
PLANNING BOARD DATE
Chairman Member
Mcrr,bcr Member
Member.. .. _ ....._......_..._.� Member ...._ ...............-- ._._...
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has bean obtained (mm
the Plannio.:4 hoard.
A re•in'p(ction fct of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials ana /or workmanship.
to me well known,