285 NE 100 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I 130 if
Legal Description Historically Designated: Yes ,, I No a •
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Master Permit # 4S
Owner's Address ( O� - ""`-"fi Phone - -g® - 6 6 1 3
Contracting Co. O `�` Address cis l
Qualifier
State #
Owner/Lessee / Tenant
Square Ft.
°UAL #\0. -TT
Municipal #
Competency # — Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFIN PAVING 1 FENCE SIGN
WORK DESCRIPTION B r i C w ci r i o e to cf -S e e Vlore 4 tc ti k e r1
io58 sii•
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date
My Commission Expires:
SS# - ne
ckv_A vLAk<030
4,2,2604'•
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.
1 OFF CIAL T LA
FIDIAS J • OPT
"NOTARY PUBLIC STATE OF FLORIDA 1
COMMISSION NO. CC622178
MY COMMISSION EXP. FEB.17,2001 I
FEES: PERMIT SV ✓ RADON C.C.F. l g D NOTARY 0 BOND 300
APPROVED: TOTAL DUE 3S jeD
Zoning Building ! ( 0) Electrical
Mechanical Plumbing Structural Engineer
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APPLICATION FOR BUILDING PERMIT
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 9 ,
Owner's Name and Address �l__.... �''� ""� It-4-11_, � No .A.E Street /00 a- 4
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
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 $
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 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 5966, Compiled General Laws of Florida, Pennanent 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 subco, et); s, o. ork to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) Of 4
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved t
(Signed)
ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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 are true.
Permit No ' 340( 11____ Date ? -45. l �
/ Read, Sworn to and Subscribed before me.
to me well known,
Notary Public, State of Florida
uilding Inspecto ` -My Commission Expires
PL v NING 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 13oard.
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.
/V/ / TA A t -
(1/