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334 NE 100 St (4)' / Ii ,p . o1 ./ ` PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date (Y)5 Job Address ,3 $O ® S+ Tax Folio I 3 2 O 3 S� GZ-� I L E a I a^ Legal Description g W I / Z 7 1 1 c k - Historically Designated: Yes No t &vner/Lessee / Tenant en r lam{ Jre r17_ L7 - L CX C'5 Master Permit # a, - Phone 3O ZSS itv `C<ner's Address 334 NE fa0 St Contracting Co. (_ U 15 . IC O C a Qualifier / O Cf �^ State # or t v Municipal # Competency # Ins. Co. 6 eif03d Architect/Engineer Address Bonding Company I Address Mortgagor Sun (rte T ' Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING (PAVING)FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost (valu jS a 42) ' 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. :, / Pre.. a''� L NOTARY 5 h - l ^ ± - . ANGELA M BECKER it COMNESSION NUMBER a Iii . Q CC786697 -Y ciO COMPASS/ON COSS/ON EXPIRES 1 OF F\ NOV. 15,200 ?_ FEES: PERMIT 6 a RADON Mechanical Sf1Ved o t\ r-e - I Plumbing ti 4/-/3 -0/ ss# /ZPhone a Or V/t vv -v f' Address Address 2 (f 0() ,UL) 3 7 d'1' f 2 0 J 0 N ►"' as o C tractor t. My Commission Expires Electrical . D S Y P OFFICIAL NOTARY SEAL , COMMISSION NUMBER ii NOV. 15,2002 Date C.C.F. , D NOTARY„ 0 0 BOND 3 7 a P 0 0 TOTAL DUE b�• a Structural Engineer g /40-c E Ptstir bOUNDARY SURVEY t." ■A4 CERTIFIED TO: ENRIC SIGNATURE LAND TITI FUND, INC., BANKUNI % LEGAL DESCRIPTION: LO AN AMENDED PLAT 0 % OF VI ACCORDING TO THE PLA" O REVISED: • X17 r< 1 1 -2 c7 I <. Emaiiwzsargo NOr VALID UNLESS EMg,C,SSEv w SURVEYOR'S SEAL • co GD/J'c N c ,Nc 25,00 0.1S' 0 tl o,; 5' G.8.5' •W• BOtIDDARY SURVEY. 422'`dr..) i 33, - )0' 53 7o' (,Q /✓G o /JE i cfs /2ES•1(Jo • 334 • N a` r\ N N tiN 0 5-vD 1(5,00'11-1* 2 1,0-r c Elev ei 4'css 'L & .1. LEGEND • FIP= Found Iron Pipe S.P.t = SET 1 /2" PIN & CAP LEl47o9 F %�_' I s S.PCP= SET PERMANENT CONTROL POINT LB47S9 q= CENTERLINE. P /L= PROPERTY LINE. O /L= ON LINE M.H.= MANHOLE. WM= WATER METER, PP= POWER POLE F.C.= FENCE CORNER. R= RECORD, M= MEASURED CHAIN UNK OR WIRE FENCE= . - W000 FENCE-. + • MASONRY WALL - CONCRETE= ,:. • , ; . • • . . * • "'' •j ? AINTENAVCE & DRF.`IAGE EASEMENT _ • RT D.E. NOTES: UNLESS OTHERWISE SHOWN, THE FOLLOWING NOTES APPLY. INSURA:CE ONLY ON TEE VALUE: OF THE 1) Record and measured calls are in substantial agreement. 2) Bearings. if shown are based on Plat data 31 The land: shown hereon were not abstracted for Easements or other recorded emcumbrances not shown on the plat and he same, i any may not be shown on this sketch. 4) Underground portions of Footings, Foundations or other improvgrner.ts were nol located. 5) Elevations are based on National Geodetic Datum. 6) Fence Ties are to the Centerline of the fen, :e. 7) Wall Ties to the face of the Wall. 8 BErR_ft.t h:_ i Sa _ ar ARE RE TO A.• ASSL D VALLc SAID F3 b C-'.' Locator Index ^;C'! D :tun. S'U'RVEY 200 t, 7 0 2.50 co ,mot // CERTIFIED TO: ENRIQUE LORENZO — LUACES, 334 N.E. 100TH ST., MIAMI, FLORIDA 33138 SIGNATURE LAND TITLE CO., G. DENNIS ROSE, P.A., ATTORNEYS' TITLE INSURANCE FUND, INC., BANKUNITED, F.S.B., ITS SUCCESSORS AND /OR ASSIGNS, ATIMA. LEGAL DESCRIPTION: LOT 8 & THE WEST 1/2 OF LOT 7 BLOCK 40 OF AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 SUBDIVISION ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 1 AT PAGE 70 OF THE PUBLIC RECORDS OF MIAMI —DADE (COUNTY, FLORIDA. 1 HEREBY CERTIFY That the survey represented hereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board oI Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments. overlaps. easements appearing on the plat or visible easements other than as shown hereon ADIS N. NUNEZ R egis :ereaLand Surveyor NO. S :ate of Florida MiniaMMEMEWSEEMEMENEW 5924 LOCATION OK ETCH SCALE: N T S M5) 865 -1200 Fax:: (305)865 - 7810 SINCE 1987 BLANCO, DANIAL & ASSOC. INC. Engineers • Land.Surveyors • Planners LB 11 4789 555 NORTH SHORE DRIVE MIAMI BEACH FL. 33141 FLOOD ZONE: • PANE, • DO DATE: 5 -z 5 - 00 SCALE: 1 "= 20' OWN. BY: F.'$IAr4 co 14 tic e) JOB No. oo— T19 X SUFFIX: :J DATE: 7 -17 -95 BASE:' t'vir1, TTV TTM'7F' nFi�iZ PERMIT NO. • ADDRESS: . MIAMI SHORES VILLAGE BUILDING / ZONING DEPARTMENT• SECTION BY DATE ZONING ELECTRICAL MECHANICAL PLUMBING FIRE PUBLIC WORKS STRUCTURAL BUILDING OFFICIAL 1. Sublet to compliance with all Federal. State. County. Wtage rites and regulations. Vittage assuntas no responsibility for accuracy oUor resutts from those plans. 2. This copy of plans must be available oa building site or no Inspection wttt be conducted_ JOB ADDRESS 3 3q NA: DOS,- APPLICANT PHONE tt APPUCATION .(€ SHEET OF / MISCELLANEOUS 41 / haevrek 0 / Id Ka-ix-se OATS COMMENTS INITIALS CRITIQUE SHEET STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, LOrchzO Ltzl does hereby attest that the (property owner) attached survey, performed by 3 tOVICO la 1 A (name of surveyor's company) performed on , is an accurate representation of the existing conditions and (date of survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. Witness(sign and print) Witness(sign and print) SWORN TO AND SUBSCRIBED before me this) 3 day of D,00 I Affiant is personally known to me,l/ producedF),DL ttS - .?O',- ,6y- /71 -0as identification. 0 PnY PU e, ANGELA M NOTARY BECKER ,- 2 1p, 0 oomMOS1ON HUMBER N, 'UP- Q CC786697 7! Q: MY COMM1ss o i EXPIRES OF F�. NOV. 15,2002 STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) v . u. i 11. - . STATE OF FLORIDA ) ) SS. COUNTY OF MIAMI DADE ) (ACKNOWLEDGEMENT-INDIVIDUAL) The foregoing instrument was acknowledged before me o ■ I t. �_ i_. • identification and did (did not) take an oath. Signature of Acknowledger: Name of Acknowledger: 4_001 by who is personally known to me or who has produced •� � b^ �9 , J 7��( ident ► • 'on and who di • i i• ot) take an oath. Signature of Acknowledge i Name of Acknowledger: Printed, or Stamped) O ,�p RY P e e, ANGELA ' NOTARY SEAL Title or Rank: * � _ ' COMMISSION NUMBER Serial No.(if any): (ACKNOWLEDGEMENT - CORPORATION) C786697 F1' NOV. 15,2002 The foregoing instrument was acknowledged before me on by , of a corporation, on behalf of the corporation. He/She is is personally known to me or has produced as (Typed, Printed, or Stamped) Title or Rank - Serial No.(if any): 1 • REVISED: _ o 3 v s J e.-3.=..?: _ I V • < J _ o • j Pl!f!! < J V m a y .■p; VALID UNLESS EMBOSSED w''H SURVEYOR'S SEAL • .° 1 -, ` v� I I � 4 zv cANG n fri O'r5' G •85' 045' •W' BO••DARY SURVEY' 51p' IiV':S 3 3 . -7 a 'B 6os - Fes.i10 . 334- o N N N to 5.3 r,h ,CLJ �JG 1(5,00‘04p. LoJ ( E. Disc o' 1: 0 V m G Cp A/1/./101 _:•3:iGn5 �___� rr, E • C_" " lev Locator Index J Q v 1,.7C; „(4, I 23a' b5 ' oi — Sg' liet14 ti ).;o ID N cry LEGEND • FIP= Found Iron Pipe S.P..0 = SET 1 /2" PIN & CAP LB47o'9 F N:: - Nail S.PCP= SET PERMANENT CONTROL POINT L64769 q= CENTERLINE. P /L= PROPERTY LINE. O /L= ON LINE M.H.= MANHOLE. WM= WATER METER PP= POWER POLE F.C.= FENCE CORNER, R= RECORD. M= MEASURED CHAIN UNK OR WIRE FENCE= • - - W000 FENCE= MASONRY WALL= CONCRETE= t•'•'r: :• •: .••.•, • ''.7 MAmr ?• .VCE b DREVAGE EASE. .`rI = D.E. NOTES: UNLESS OTHERWISE SHOWN, THE FOLLOWING NOTES APPLY. INSURANCE ONLY ON Ti:E VALUE OF THE SURVEY 1) Record and measured calls are in substantial agreement. 2) Bearings. if shown a.e based on Plat data. 3; The lands shown hereon were not abstracted for Easements or other recorded emcumbrances not shown on the plat and ,he same, it any may not be shown on this sketch. 4) Underground portions of Footings, Foundations or other improvemer•.ts were not located. 5) Elevations are based on National Geodetic Datum. 6) Fence Ties are to the Centerline of the fen,:e. 7) Wei! Ties to the face of the Wall. 8 HF.. NC h:IN SHOW ARE _ REFEREEDi '70 AN ASSU,`"ETJ VA.LL.E SAID FFB i s G? State or Florida • CERTIFIED TO: ENRIQUE LORENZO - LUACES, 334 N.E. 100TH ST., MIAMI, FLORIDA 33138. SIGNATURE LAND TITLE CO., G. DENNIS ROSE, P.A., ATTORNEYS' TITLE INSURANCE FUND, INC., BANKUNITED, F.S.B., ITS SUCCESSORS AND /OR ASSIGNS, ATIMA. LEGAL DESCRIPTION: LOT 8 & THE WEST 1/2 OF LOT 7 OF AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 1 AT PAGE 70 OF THE PUBLIC RECORDS OF , MIAMI - DADE 1COUNTY, FLORIDA. I HEREBY CERTIFY That the survey represented hereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board ct Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments. overlaps. easements appearing on the plat or visible easements other than as shown hereon ADIS N. NUNEZ P.egis:ered'Land Surveyor NO 5924 L O C A T I O N SCAL (305) DATE: y -z -00 0 O ;,5 865 -1200 SCALE: 1 "- 20' ("KETCH N HS DWN. BY: F.'SIAt1 CO 19 14 I')) ; tls BLOCK 40 SUBDIVISION SINCE 1987 BLANCO, DANIAL & ASSOC. INC. Engineers • Land_Survevors • Planners LB 11 4789 555 NORTH SHORE DRIVE MIAMI BEACH FL. 33141 Fax . (305)865 - 7610 SUFFIX: :J DATE: 7-17 -95 BASE :'" NT a TTV 71742r nR6 JOB No. 00- B�9 i • s 1 REVISED: piA NOT VALID UNLESS EMBOSSED WI'H SURVEYOR'S SEAL . BOUNDARY SURVEY 'Go2 .0 f of (,D Elev. Nozv p2:„. Locator Index LEGEND • FIP= Found Iron Pipe S.P.C. SET 1 /2" PIN E. CAP L64759 F -nJ I Di s c S.PCP= SET PERMANENT CONTROL POINT L64 7E9 q' CENTERLINE. P /L= PROPERTY LINE. 0 /L= ON LINE M.H.= MANHOLE. WM= WATER METER. PP= POWER POLE F.C.= FENCE CORNER, R= RECORD, M= MEASURED CHAIN UNK OR WIRE FENCE= • W000 FENCE . MASONRY WALL CONCRETE= t:.-,', ;• .. •1.1 MAINTELANCE & DRCLAGE , EAS&`g■rr = Rt b.E. NOTES: UNLESS OTHERWISE SHOWN. THE FOLLOWING NOTES APPLY. INSUF.A:CE ONLY ON TEE VALUE: OF THE St VEY 1) Record and measured calls are in substantial agreement. 2) Bearings. if shown are based on Plat data. 3) The land! shown hereon were not abstracted for Easements or other recorded emcumbrances not shown on the plat and 'he same, i; any may not be shown on this sketch. 4) Underground portions of Footings, Foundations or other impro were not located. 5) Elevations are based on National Geodetic Datum. 6) Fence Ties are to the Centerline of the fenl•e. 7) Wall Ties to the face of the Wall. 8 EL -R_ts. h: Si :CX�' ,,.RE _ RE<EP. TO AN ASSL �D ' kJ..= SAID F3 F GS o.IS' L O C A T I O N S K s C A L E kr) N TS 4 E T C H . 1`i la 11 14 14 1 t 1 5 ' CERTIFIED TO: ENRIQUE LORENZO — LUACES, 334 N.E. 100TH ST., MIAMI, FLORIDA 33138. SIGNATURE LAND TITLE CO., G. DENNIS ROSE, P.A., ATTORNEYS' TITLE INSURANCE FUND, INC., BANKUNITED, F.S.B., ITS SUCCESSORS AND /OR ASSIGNS, ATIMA. LEGAL DESCRIPTION: LOT 8 & THE WEST 1/2 OF LOT 7 BLOCK 40 OF AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1 SUBDIVISION ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 1 AT PAGc 70 OF THE PUBLIC RECORDS OF MIAMI —DADE ;COUNTY, FLORIDA. I HEREBY CERTIFY That the survey represented hereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board cf Land Surveyors pursuant lo Section 472.027 Florida Statutes. There are no encroachments. overlaps. easements appearing cn the plat or visible easements other than as shown hereon • ADIS N. NUNEZ Regis :erectLand Surveyor No. 5924 State of Florida (305) 865 -1200 FLOOD ZONE: ' VD . DATE: 5 -z 5. -00 SINCE 1987 BLANCO, DANIAL & ASSOC. INC. Engineers • Land • Planners LB # 4789 555 NORTH SHORE DRIVE MIAMI BEACH FL. 33141 0033 SCALE: 1 r1 = 20' SUFFIX : :J DATE: 7 -17 -95 BASE:'" (`• NT u TTV TTrAF; nR4-z. DWN. BY: F.'31A14 CO Fax ; (305)865 - 7810 JOB No. 00- 919 WHEREAS, .Nerd Lazo Laces , hereinafter referred to as the Owner of the (owner) following described property: Legal description /folio #: pRwECU/+y /j PPS er}ctt v /iami SIiorej (/iCfccc�e 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 . (3051756 -8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Lot cod tie — 1 Block 1 Subdivision I ' is S C. ) ) D T A io.• o Tax Folio #: / ZO Q 13 SVSV requests permission to install: halt concrete, brick pavers [ Landscaping [ J Other within the public road right of way of .33 L/ N. P, 10© (ad ress) IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as follows: I . To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE o t.' •ay o yew .— - SIGNED. SEALED AND DELIVERED in the presence of. 8 114.11 Enzfc?uE e?oea, fine. g enezaLeonhado, # CGCA03068 7800 N.W. 34th Street, Suite 205 Tel.: (305) 418 -4555 Miami, Florida 33122 Fax: (305) 418 -4898 • BUILDING ❑ ELECTRICAL ❑ PLUMBING ❑ ROOFING MECH O B H of Lye) C •e4 Architect Contractor or Builder Legal Description Address of Building MIAMI SHORES VILLAGE, FLORIDA PERMIT 33y/iief6 s t ILDER N II Date Contractor's License No. BY AUTHORITY 10 ai Work to be performed under this Permit - 7 ) .e roa /J 1-) /ia4lu 5 ae 1 i , Co k r7 r✓� r A� . 7/y/t1a/,i irk / 2, 1 f3 n�b CCF: Permit: / Subdi- n /" nob I. c y� 0 7 i S S Radon: _ Valuc of i Amount of Project S (0(.,(4/ Amount 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 applica- tion berefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with an 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 n med above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shownoe plans or drawings or in the statements or specifications and that be assumes respon• sibility for work done by his agents, servants or emp ' Signed' (II �PEG?OR) BY 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 is permit I assntne esponsibility for all work done by either, myself, my agent, servant or employee. 0 --� BUILDING . [ '` ELECTRICAL ❑ M PLUMBING ❑ PERMIT ROOFING ❑ MECH 0 4 , Owner of - Building .A0 r - 1J _ v Architect Contractor A or Builder e I) l 5 ` (t X'nt... Description Lo }U l ix 11 BI.?) Address of �( Building `3 31 iE /no 5 MIAMI SHORES VILLAGE, FLORIDA Date 48329 .. n....+._.._...+..._. �i........�..._.1�e.`.- .._.._c- .a a.. x..,.... a..: a. 1. w_. a: i ._v._..�._....a�.::�:k=.:.._... ......ice ._. .. .. �.a .. 1 -.. Contractor's License No. Work to be performed under this Permit /Os A d/ Cf' r■i(i S 481,9c is Subdi- 0 ' Q yam' n/, d vision P .i. l� -� 7 Sq. Ft.: Value of Project $ 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 applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any '. ) plane, drawings, statements or specifications that may have been submitted to' and approved by the proper municipal authorities. This Permit may be revoked• r` 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 respon- sibility for work done by his agents, servants oremployees. Signed- t SPECTOR) BY t - ▪ '1 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 V pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting t 's permit 1 asume re ponsibility for all work done by either, myself, my agent, servant or employee. 8426A200 05/07/01TOTL 365.60 BY AUTHORITY 20 • Permit: ', t/lO /n CCF: 1 1!> a Notary: "!-- Bond: • - • Radon: Amount of 3 j ( � (� Permit: C/ ..l �" . 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. O wner's Name and Address Name and address of licensed contractor New Building Remodeling MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date -(44ee )1 19 r NR& % Street 7 e /ia y - ! Registered Architect and/or Engineer Locat' and llegalal description of lot to � be built on: �Jy►—Q / At r2 " .? 1 Block '/ O Subdivision Yr � I Q „_ + �/ / ,4 /417 n /1 fo t b / 3 ,AIS z l Street and Number where work is to be done 3 3 / ,! 6 /69,e 5 , )State work to be done a purpose of il¢in (by floors). state exterior colors (submit samples) �� s .0�� �eezfi and for no other purpose. Addition Read, Sworn to and Subscribed before me. Repairs No. of Stories TToo be constructed of Kind of foundation Roof Covering VEstimated Total cost of improvements S �/ � ® C' Amount of Permit S 3 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live Toad to be borne by each floor I hereby submit all 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 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 p ' 't: and will p t 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 undersign agrees to e• ploy only such tractors, on work to be performed under this permit, as are licensed by Miami Shores Village. n 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. ..?/'” 7 Date Disapproved Date (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 825.00 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 825.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. Notary Public. State of Florida • u oxtg-9 1 - $4 0 1 Y- o i ) 9i ; 4 1 A' y /rrt-- Cam. t cc r iw NE / Tv S" rtkrr:i1C. :.11.ero;C 5 co gc • :)..t-t.t, - 1 -- YEW'. VENT 9 c P. . who. -- A 1 1 0 . 14 g ELE V / Fort VEACTS•