1420 NE 101 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date N Address , f �� )\‚) F tf
Legal Description
,Owner / Lessee / Tenant ' GJL4 2 O r p ( rt j Master Permit # 2
Phone 7
Owner's Address / 0 N . ) l )r \
Contracting Co. \ C>Cd nt Pr
Qualifier
SS# - -
Address
Folio
Phone
State # Municipal # Competency # Ins.Cc' \il
Architect /Engineer Address
I i Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION .a{ot�- *ol.'P - tdi— L d 144-er
Square Ft. Estimated Cost(value) . 00
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
.41 1
ature of Contractor or Owner- Builder
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President Notary tow
My Commission Expires: My Commiss€'q
1 :n
I,f
** * * * + * * * * * * * * ` F
FEES: PERMIT +`I ° RADON C.C.F. NOTARY
APPROVED: Fire
Zoning Buildin
Mechanical Plumbing
Sig
Dat
ENFANI`MA RA MONTIEL
* COMMISSION NUMBER
`c CC401281
U O
Q P Y QgOPAMISSIpN 'EXP.
__ - A NI 171998
Other
Electrical
Engineering
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.
Date 1C �- 1
v Owner's Name and Address
() L4 N (4 4 \ 4 U J 1 1 / No. Street ✓
Registered Architect and /or Engineer p�
(.Na Re �me and address of licensed contractor JL l )
Location and legal description f I t to be built on: 9
Subdivision � A t /1 J,o5' °l3 6 ej /
C.St�eet and Number where work is to be done
1 4 la! S -�
v Siete work to be done and purpose of building (by floors), state exterior colors (submit samples)
Lot 7L Y1 D 1 , Bloc
and for no other purpose.
New Building Remodeling
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
To be constructed of Kind of foundation Roof Covering
stimated Total cost of improvements S 120, e Amount of Permit S , 7 / g /,5T
Zone cubage required - Plan Cubage
Distance to next nearest a- - Size of Building Lot
Maximum live load to „L„
I hereby submit all F
p88
The undersigned applicant 2IC noes hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's
Compensation Act, being Sec o: 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 es mploy only such subco_ tors, on work to 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 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 igpplication, and that he did sign the same, and that all facts therein by him stated are true.
Permit ' No.
Disapproved
(Signed)
Building Inspector
Date 1 Read, Sworn to and Subscribed before me.
Date
Addition Repairs
PLANNING BOARD DATE
No. of Stories
g. All notices with reference to the building and its construction may be sent to
Notary Public, State of Florida
My Commission Expires
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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.