230 NE 101 St (12)1
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
2 35 /�/ /d/ si
Job Address
Tax Folio// 5c. Fb 0 W
Legal Description W ( Si/ 1149 j ' k^tt) Master Permit # t /7V
/ Lessee / Tenant _7 ,g—.5 A es le /? / S
Owner's Address p AO /Yea /e,/ ` / phone 76, 7 ?.-
Contracting Co. d W ilia n, Address
Qualifier SS# - - phone
. State # Competency# Ins . Co.
Architect /Engineer
Bonding Company
Mortgagor
Address
Address
Address
Permit Type (circle one : BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft.
/ � )C /616, ,9770 ,SLR
Estimated Cost p O
de
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. 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.
�J71�il
Sigma e of Owner nd /or Condo President Signature of Contractor or Owner - Builder
9A3d Date:
Dat
/4.(4k,v,%4/
Not'ry as to Owner and /or Condo President Notary as to Contractor or Owner - Builder
My Commission Expires: 4 My Commission Expires:
* * * * * * * * * * *
PERMIT FEE: APPROVED:
'31,0 Zoning ectoo
1 �`� Mechanical
Fire
Building
Other
Electrical
Plumbing Engineering
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THESE PLANS ARE APPROVED FOR ISSUANCE OF A BUILDING PERMIT
E] WITH NO VARIANCES ❑ WITH VARIANCE(S) LISTED IN ' REMARKS"
NO OTHER DEVIATIO "S FROM THE MIAMI S'.nRES BUILDING AND ZONING
ORDINANCES WILL BE PERMITTED. UNI ESS SPECIFICALLY LISTED BELOW.
ALL OTHER APPI.ICABI.E STATE AND COUNTY LAWS MUST BE COMPLIED
WITH BY ALL PARTIES.
FIRE DEPARTMENT
PUBLIC WORKS
POLICE DEPARTMENT
BUILDING DIRECTOR
PLANNING & ZONING BO ;UO
VILLAGE COUNCIL
REMARKS:
Authb•i'ed Stniture
APPROVAL
PRELIMINARY: FINAL
COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED
BY MIAMI SHORES VILLAGE IS REQUIRED. THE IARC EITECT, BUILDER &
SUB CONTRACTORS ARE CHrrED WITH
ING REGULATIONS WHETHER OR NOT SPECIFICALLY INDICATED HEREIN.
Date