GuttersPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 12 4 0 Job Address 11'1 14E /00 S j Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Fn Ziet c' K - j ELL '4
Owner's Address 1 $ - i ra t , O S'Y
tJ S
J N - A
Contracting Co. ;� 'd • ° Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company
Mortgagor Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I 'Reno, 1 nl t • 4' < R S 2 PA 'T LS'PC T� ..
Square Ft. Estimated Cost (value) ('SCO 0 - p n
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 (W 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 understar' " r ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be : laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
, ,9,0-le -Vac /co
Signature of own and/or Condo PrZt 1 i Date Signature of Contractor ( Date
2 -AV 7-25--eV
Notary to Owner and/or Co do a j; Date Notary as to Contractor o )ate
My Commission Expires: OFR I YSEAL My Commission Expires:
GLADYS J VILIAR
NOTARY PUBLIC sum OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1 ,2002
FEES: PERMIT D RADON
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F. r G 0 NOTARY
5/0
Phone (305 7 S
05977 - 3 . 2 3 W
Electrical
Master Permit #
Phone
Ins. Co.
BOND / O
TOTAL DUE
Structural Engineer
J
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 J. > O U{^ 7 /1
Registered Architect and /or Engineer
Name and address of licensed contractor
08F11 06R8'97
Location and legal description of lot to be built on: � � -
Lot !1 Block Subdivision 7'4 / 13 /(l // J0{ q I6 13 e /�6 /� 3
Street and Number where work is to be done , S 7 ■VE, oo �S r
P4or FXTFT toi J94/v
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
y
00/11G5 oN /1127
and for no other purpose.
New Building Remodeling Addition Repairs ✓ No of Stories
To be constructed of King of foundation Roof Covering
Estimated Total cost of improvements S to 0 Amount of Permit S ✓
0
Zone cubage required "---.— Plan Cubage
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said buildin
Yellow Wood
Remarks (Signed)
BM -74 -25
ing and its construction may be sent to
Date Q �IoV
No. / )y f 19 g
(J Street /'
7 /t
-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 agrees to employ only such subcontractors. on work to be performed
under this permit, as are licensed by Miami Shores Village.
•
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. 0 9C6 V 0 Date 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 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.