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185 NE 100 St (18)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date / 7 - ; Job Address 4 /VJ /0 5f Tax Folio // ,P /3 &07 7' Legal Description o2 / 4 d /3 V e 6 Lei l Owner / Lessee / Tenant l'& /1y (.2"/e4A) Master Permit #0 Owner's Address YTS /W5. /00 V• Phone 9 79 1 '/ 1 i 93/ 0703 5 ' 1 Contracting Co. c�Gt)�/� �/✓S7i0l�ib7 - /o � Address Qualifier / l( L CAC/Z-2 ss# - - Phone 633-.22/9 State # Municipal # Competency it / al77 Ue Ins.Co. C6/4 hiefr? Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one)): BUILDING LECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ...4 G /e /e,o G ge.e ''i ci 7 3 /o/ti C).✓,/Z,o( ,G awe 7' /O/4) ,4 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 constructio . o�� "` "`B;• JOSEPHINE CHURCH authorize the above -named contractor to do the work stated Q r 7 tl ' • Notary Public, State of Floods • Fay .. My Commission b4 Aprils 1998 11M Ammwmw e of CQ0-1 or • caner-Builder Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: y Commission Ex i nr .e or stamp name of Nota Public ` d ot. fy as to ContTremtntirbegr ❑ DID take an oath, or pa. DID NOT take an oath. ** * * * * * * * * * * * * * * * FEES: PERMIT 00 RADON C.C.F. NOTARY ` TOTAL DUE, X27 TPg Mechanical Plumbing Engineering ** APPROVED: Fire Other Zoning Building Electrical: / y�' / IcIP Legal Qualifier Square Ft. APPROVED: / Lessee Owner's Address Co. Contracting Description °5 / Tenant /Ai' � d/ /'Z Master Permi 4 _ 7007 / A-' ,. , / 7 J 2 7 / phi r' '2riJ / Phonefr '7,f �" ? 2/3 • 'Y5/6A eik5il,) a,u Gl_ eag,6)-- Address ‘,2/ N) F // 45 e -3 / ,12S, State #k 16-° Architect /Engineer Address Bonding Company Address Mortgagor Address Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address / ?- 5-." dI r' /a Tax Folio // J &( /5 Add/ 3 /5 /0/P 3aPTC gec 9sbare ss ## Phone - a‘> g 11/t Municipal # Competency #..1577 is Ins.Co. - V 75 :4 # A_." Permit Type(circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION � � 6 d� 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 a thorize t above -na '-d :ntra'tor to do the work stated. Signature o Date do President Note y as t %vwn r and / r Condo President ?My Gominission:- -Ei pires: ., „ - :; rR' ;,1 Y U.. iISS;'a. E j' i "193:: 6l.v.'`' .Iii iJ �L, r.,;i. L.�'J,. UI•.b•. *: * �� * - * j _ * * * * FEES: PERMIT Vt! RADON Cost(value) � -v {�,� � y B ilding Mechanical l Signature of Contractor or Owner- Builder Date: 7- , - Q My Co Aff e t1' FLORIDA- MY t u�•�,'•iISS GN EXP JUNE 30,1994 BONDED TFiRU GENERAL INS. J D. N C.C.P. / NOTARY TOTAL DUE 6 Fire otary as to Contractor or Other Electrical er -Biii lder : Engineering h DADE: 949 -2679 PRECISION AIR CONDITIONINI f 2162 N. E. 162Fid it5r ° t �t i State ,Certified 06104 06§i rt 5 tRi A 11ON'CORP � �r r.•z . +:�r.d / S . 4300-226-K0ot_ f' fur g•m r �r Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing 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. _ Date. Owner's Name and Address. • 6P Registered Architect and /or Engineer... - Name and address of licensed contrac Location and legal description of lot to be built on: Lot Block Subdivision // Street and Number where work is to be done__ 8 �� 100 ...d2/4 Stag work to be done and / p im pose of ildi ng (( flo rs)_ 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 $__. — Amount of Permit $ ✓Y OU 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 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 pennit does hereby certify that he understands and accepts his obligations 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 agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. R.emarks (Signed 4 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 stated e e. Permit No.____ . t. Date_. f ' 6 I Read, Sworn to and Subscribed before me. Disapproved ___ Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT t _ 19 tl No. Street__ to me well known, Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member 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 been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.