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270 NE 100 St (8)D Ir°I Type Insp'n T -fit Permit No. 1::15 — 10 Name 3-. C.L. Skr-t 4. Address 2 70 ' too ST Company Q'AP Phone# ( 4j L — q • Sq 0 , Inspection Date C I i q ICES Approved Correction Re- Insp'n Fee 55 MIAMI SHORES VILLAG BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2005 -510 Printed: 4/26/2005 Applicant: CARMEN Owner: COSTA JOB ADDRESS: 270 NE 100 ST Contractor Local Phone: Parcel # 1132060134450 Signed: Building Permit COSTA CARMEN Contractor's Address: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 3 & 4 BLK 33 LOT SIZE 100.000 Fees: Description Amount FEE2005 -5207 Building Painting Fee $60.00 FEE2005 -5208 CCF $0.60 FEE2005 -5209 Notary Fee $5.00 FEE2005 -5210 Training and Education Fee $0.20 FEE2005 -5211 Technology Fee $1.50 Total Fees: $67.30 Total Fees: $67.30 Total Receipts: $67.30 Permit Status: APPROVED Permit Expiration: 10/8/2005 Construction Value: $500.00 Work: PAINT HOUSE EXTERIOR (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 , die, ,• wl , BUILDING Permit No. ,P)rinS —S ( U PERMIT APPLICATION e Ma Permit No. FBC 2001 a. ., a . • , • • Permit Type (circle): Building Electrical Plumbing (,� `M e anic Roofing Owner's Name (Fee Simple o der) Hen �� (Oil jean ucua n 1 35'' - Iq i' 3)w/05 15Q t5 / Owner's Address 210 Ne cost yy � t City M l (�'Y) I shores State F Novi cl G Zip 632e Tenant/Lessee Name Phone # Job Address (where the work is being done) Z10 N t. Co t5t ree 1 City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name C)C.sLy1( r Phone # Contractor's Address City State Zip Qualifier State Certificate or Registration No. Describe Work: Total Fee Now Due $ I �� _ CI (Continued on opposite side) Certificate of Competency No. Zip 3 ) 55 Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit c5. ,Q (,) Square Footage Of Work: Type of Work: ['Addition ['Alteration ❑New ❑ Repair /Replace ❑ Demolition th whOte h(L4 s-e .and roof • Submittal Fee $ Permit Fee $ GO I CO CCF $ i CD CO /CC Notary $ , > < Y) Training /Education Fee $ ( c -J Technology Fee $ ( - S 0 . Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site JO,- the Jirst inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not approved and a reinspection fee will be charged. Signature Owner • Agent The foregoing instrument was acknowledged before day of , 20C, by bra rQj who is personally own to me or who has produced As identification and who did take an oath. NOTARY PI Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPLICA'T'ION APPROVED BY: Clic 05/13/03 Signature The foregoing instrument was acknowledged before me this day of ,20 ,by -- who is personally known to me or who has produced_ _ as identification and who did take an oath. NOTARY PUBLIC: Sign: • I _ J I,xpnr i ;. 10 r My Commission Expires: O Print: Contractor ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * **** * * * * * * * *tj* A ft**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning 7 Signature )/ Lt £n Miami Shores Village Paint Color Approval and Agreement Date HMO ,p c j� )5-15(40-1015 Owner's Name -1e ) (6 sG I 1 Je ciccuct'C J� i ' Phone # OS t !Q 1 - 7) CO (D L i Owner's Address ,1 Q (\l E (W SI €C 1 '�� City W I �W I S JI 'S State r orld6 Zip 3 Job Address (where the work is being done) 10 N L S C a City Miami Shores Village County Miami -Dade Zip �� 138 Is Building Historically Designated YES Walls Fascia Drip Cap /drip Ed Soffit Roof Flower bins Shutters Awnings Chimney Doors and door jams Garage doors 3 (O 1 S� Railings Fences Decorative metal All brick (simulated or regular) Stucco banding Any other stucco features Accessory Buildings Owner or Agent NO .X APPLICATION APPROVED BY: P& Zicial Phone # Contractor's Company Naine (if applicable) ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted e Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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. Date 1 11110 Date 7////' 5 chc 6/18/03 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date / Job Address 1Q S Tax Folio 11 • 3200 • O (b • A4'50 Legal Description Sr-- $3 Lots 3 44/51114. t IN-Q 14( torically Designated: Yes No f•a► / Tenant tl Lep1r- l'� �l,• o "',& ��A Owner's Address 5 L •Ol LC nJe 50Z- N�1�1'` M,1- A . Phone S ` ��C7 e i C o n t r a c t i n g Co. $ i rI CA l 0 W Address 5 de. Qualifier State # Architect/Engined0 Bonding Company _ Mortgagor My Commission Expires: APPROVED: Zoning Mechanical Notary as to Owner and/or Condo President Date FEES: PERMIT RADON C.C.F. Master Permit # Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTIOlt y Titersounif-- cvEysorl k- (31:740T 1 6 , 44“-b - rs-0 4-‘ . l f6)50 - Fber6at a' -) t0),P 3R- '�(�2'Tlo� e rat_ i t `��dZ lV fL 2FT (t�IJCN Jr',..)tt(P ps ocei J - - Maga f Square Ft. tikr. I t* Estimated Cost (value) k k Mo 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 . . i ork stated. Signature of owner and/or Condo President Date Signature of Contra Notary as to Contrt(ctor of Owner - Builder My Commission Expires: / _ z 7 —0 c y oF:m 13E . TAT_ o F ¢/6ru'4 1 Date -tef �/ .N � ' ham XIMA S BECKMAN Co vrv` 4 T �A � e✓ .otary r - Ih S -/ G I -SG - ZS71 -0 ' Wt� !?rr�. a 10/27!00• 3 �i �� `• C rm; CC6903A1 t public W`.;.rite of Florida NOTARY trO /111' `` or ctlD' TOTAL DUE Date Building I Electrical Plumbing Structural Engineer PERMIT APPLICATION FOR MIAMI SHORES VILLAGE e AsA Date 7 t HH `� Job Address /2:2 0 Ta 1 0 r Tax Folio Legal Description Lessee / Tenant 1 -1- 12)0 57 A-.- Master Permit # Owner's Address `D L 7 \ a � Phone e ( - l4Eb `_- Contractin Co. Address Qualifier SS #' = Phone State # Municipal # Competency # Ins_ gineer Address Bonding Company Address `z- Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION --'C 1 _ NJ - V ut r S 4 ` 77eA 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 au the above -named contractor to do the work stated. Si Date: APPROVED: 1 Notary as to Owner and/ Condo President Notary as to Contractor or Owner-Builder My Commission Expires: I ,1p,CZY P(/ OFFICIAL NO SEAL 2 (- -- ,r n TT SCO W DAVIS * .. * COMMISSION NUMBER ** * * * * -7�F `r � O MY COM S SION 7 EXP. ' * OFFl"° ..._.,_ IAN. 26,1997 FEES: PERMIT % 1'- .} " RADON Zoning or Condo President Signature of Contractor or Owner- Builder Date: My Commission Expires: NOTARY * * * * * * ** TOTAL DUE t e5 4 4i Electrical Mechanical Plumbing Engineering Registered Architect and /or Engineer Name and address of licensed contractor The unc Compens complian on the sit under thI 2H4F Cleome Pink Remarks STATE OF FLORIDA COUNTY OF DADE. } SS. 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 Address0‘ek■ voksirsee-A t Ova§-1-- Location and legal description of lot to be built on: / � y �//� Lot , -3-4 4 # Block 4 -.5\,.:; Subdivision ,$, /�A1 �°v'1 �/ / 7$ iY Street and Number where work is to be done a o State work to be done and purpose of building by floors), state exterior colors (submit samples) r ` e. PAAC,,� a- 4.1m arep' rae o I X0 ro C}aE � pszvyrrE -s3 2k'4 4f. (�0 G . + .te Sia.A.p* picA,Ca'T { r TetaS. 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 $ 6 . / � S Amount of Permit S \3 , Zone cubage required Plan Cubage 1 Distance to next nearest building Size of Building Lot `■'5 tO Maximum live load to be borne by each floor I hen \ `aid building. All notices with reference to the building and its construction may be sent to es hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's sral Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar iployed by him in the work to be performed under this permit: and will post or cause to be posted for inspection is are required by the Act. The unde es to employ only such subcontractors, on work to be performed /illage. (Signed) 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 foregoi ' g application, and that he did sign the same, and that all facts therein by him stated are true. Permit No. // �D Date ' to C) Read, Sworn to and Subscribed before me. Date `� tO 19 v10 No 2l0 Street 1, 1 Disapproved A 4_ y' -- t 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal of the detailed statement ut iste 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 Miami Shores Village. Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and ill . 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 i Owers Name and Addre Name and address of licensed contractor •••••••nterin, v.■.•■••••••re I gr_vst.y. 19 n'ss itg......202(.1mL. 2 61±,z. No 2 - 70 og-t 7 Registered Architect and/or Engineer__ ...... c CLIti - Co 4 3 7 V& / np/ Location and levl description of lot to be built on: // jge6 13 Itt4 e Lot- "i" _ B1ock.23 Subdivision Street and Number where work is to be /M /do s State work to be done and purpose of building (by floors). f /La 4 cs_ and for no other purpose. New Bui!ding Remodeling.— Addition.............. ..... ....... Repairi No. of Stories...... — Roo vering. 7 Le ' To be constructed of .. Kind of foundation.....---- Estimated Total cost of improvements t.....f2 _ izaf2:: 0 Amount of Permit 4 4 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.. 77 e P P la . .3/1 If The u ndersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e mploy e r of labor under he Florida Workmen's Compensation Act. being Section SOK Compiled General Laws of Florida. Pennanent an has complied uith the provisions thereof. and will require similar compliance from all a actors r 6-contractors ernpluytd by hi in the work to bc performed under this permit; and will post or cause to be posted for in .•ec •n on 4, site of the work such public notice or notices as are required hy the Act. The undersigned agrees to employ only such str• .ntra ? ors, ,/ work to be performed under this pcnnit, pcnnit, as are licensed by Miami Shores Village. Remarks (Signed) 4 1' /‘ 7 / STATE OF FLORIDA, COUNTY OF DADE. SL Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgmenu, 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 appl tion nd that he did sign the ram e, and that all therein by him stated are true.. Permit No. • Date.5A.C.1._E.7— R ubscribed before n ,.....-,,, Disapproved -.-. — -- Notary Public, State o Fion --- (Signed ._ Notary Public, State of Figla Building Inspector Commission Expires. ---MTCBTAintssioll E D. 23, 1990 Bondod That Troy fain • lnsuranco Inc. PLANNINC BOARD.--- -- DATE Cilairman Member Niember . ...— --. - Member Member - — ------- Member Council Approved - .-.— Date Disapproved .- - - — Date (11 A charge of $1.00 will be made for making corrections or changes to this application after approval has heen obtained fmtis the Plannit...: guard. A rv-sii•pection fee of 31.00 will be charged when such re-inspection is made necessary by improper notice for inspes.-tion or faulty materials anu/or workmanship. to me well known, Owner's Name and Address . MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby mode for the approval of the detailed statement in 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... _ t ;:2 ._ ^..._.... ,19. - Q r T r r rs v _ No.... a ..7 . Stra ;.fC .l Registered Architect and /or Engineer .,:a n,•• t,nenoer. Name and address of licensed contractor ce . l .._ Location and legal description of lot to be built on: Lot Block Subdivision . __..___....._._... »... Street and Number where work is to be done a y /d s.. . d _ ._ _ ._ ..._... — State work to be done and purpose of building (by floors )...-__P-41.423.-/ / ''te ° ....._....._. s-_.._ , 2 1 1 1 .13.:_Q r and. for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Rirtof fouunddaa ' on Roof Covering Estimated Total cost of improvements $ A `� Amount of Permit $. r St. ...0 Zone cubage required plan Cubage Distance .to next ne.uest 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 perinit does hereby certify that he understands and accepts his obligations as an t•mployer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied ssith 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 ubcontractors, on w9rk to be under this permit, as are licensed by Miami Shores Village. � Remarks..._ (Signed) Building Inspector 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 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 carej.uIly read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.. Permit No.. a 3 .2_i/ Date �,1" Read, Sworn to and Subscribed before me. Disapproved . Date .._.. Notary Public, State of Florida (Biased) MyCommission Expires _. »..._........ ».._..._.._. PLANNING BOARD DATE Chairman 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 (min the I'I.upni,. (Board. A re.in.lpestiun fee of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty materials anti /or workmanship. ( c33 ))6. oco 6 f�4 s fit, (9),,,,?__ BUILDING E" ELECTRICAL ❑ PERMIT N? PLUMBING ❑ ROOFING Owner of Building t Architect Contractor or Builder Legal Description Address of Building Lot ❑ Work to be performed under this Permit This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. \�.. Signed: BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In a in this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. 1 f,.. CONTj R BU El �P BY AUTHORITY MIAMI SHORES VILLAGE, FLORIDA 1.: fl 14682 Subdi- vision Value of Project $ DATE - 195 Contractor's License No Amt, of Permit $ MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT; APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the deviled statemen of the plans and specifica.ions herewith submitted for the build- ing or o h. :ructure her i described This ri-licat,c is made in compliance and con•o'm ty w.th the Building Ordinance of Mia ii Shores Villave, or da, and all pro isions of the Laws of the State of I krid. all o d nances ,f Mi ni Shores Village- and all rules and regu a ion. of the Building Div.. i of lain Sho. iilage b '1 ,e o• ipl.ed with, whether herein specified or not. A copy of approved plans and specificati .n•• must be kei at bui :ding durin progress of tl.e wcrk. Owner' Name and Address.__._. / ' ` • 7-1/1 / e/ 4 g 4 !'o� Registered Architect and /or Engineer_ Name nd address of licensed contractor. A//9 )6 ®se itc, e -i - 2 .jv r. 7rte'. Location and legal description of lot to be built on: Lot. Block__. ____ cOSubdivision Street and Number where work is to be done `e+ 01/ / ' State work to be done and purpose of building (by floors) Date 5-// 19_' A/E' Street_/ and for no other purpose. New Building_ _ Remodeling__ ____ . __. Addition____ ____ ___ _____ __ _ Repairs. _ _ _ No. of Stories. To be constructed of_ _ _ Kind of foundation Estimated ". ,tal cost of improvements $__ Amount e`. Permit $__ Zone ^ubage required_ __. _ _Plan Cubage Distance to next nearest building_- _ . . ___Size of Building Lot -- - Maximum live load to be borne by each floor. _ . _____ hereby submit all the plans and speciiications for said building. All notices with reference to the building and its construction may be sent to The unde signed appli ant for th's building permit does hereby certify t tat he understands and accepts his .•bligations as an employer of 1 bor under he Florida Workmen's Compensation Act being S. -tion 5966 Coi p led Gen al Laws of Florida P r anon Sipple Went. and h s compl ed w he prov' :ions thereof, and will require s•milar comn lance from all contractors or sub-contractors emplo •ed by him in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public not' e or .otites as are requir d by the Act. The u. d.r ign.d agrees to employ only such abcont . ctors, on work to be perform d der this permit as are licensed by M am. Shores 1 it : ge. Remarks (Signed) - -- `� STATE OF FLORIDA, LG�� ��� COUNTY OF DADS. ss• Roof O �ov gyring__ Before me, the undersigned authority, a notary public, duly authorized to adn:_nister oaths and take acknowledgments, personally ap- peared _. and who, being by me first d. ly sworn, upon oath depo and says that he is the of th abov de .. ibed istruction t. • h has careially read the foregoing application, and that he did sign the sane, and that all facts therein by him statehar4 t Date__ __`� _ Permit No � v .___1_ .. Read, Sworn to and Subscribed before me. Disapproved (Signed) - - -- - -- - - -- --- - -- PLANNING BOARD DATE Chairman _. __ _ Member _ -• .- ...- Member ____ Member Member _ Member Council Approved _Date Disapproved -- .to me well known, Notary Public State of Florida ng Inspector My Com :nission Expires. Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application tftcr approval li is been obtained from the Plain- ng Board A re--inspection fee of $1.00 will be charged when such re- inspection is nm:.ie necessary by improper notice for inspe :•t•:m or fa. Ity materials and /or workmanship.