Paintot-)2
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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
v '
Street and Number where work is to be done __....._ it
State work to be done and . pose of building (by floors).
STATE OF FLORIDA,
COUNTY OF DADE.
and who, bein g
of the above
therein by hi
Permit No
Disapproved
( Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date
Date
Chairman
Member
Member
Council Approved
o d
No.
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 pennit 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 subcontractors, on work to be performed under this
permit, AS are licensed by Miami Shores Village.
Remarks (Signed)
-/d
P / , ,9 c2
NStreet. / Q -
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
by me first duly sworn, upon oath deposes and says that he is the.
described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
ted are true.
1 Date " 7 - s7 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
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 Board.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
• /r
CONTRACTOR OR BUILDER`
MIAMI SHORES VILLAGE
PERMIT N? 5019
Bl
t /
. FLORIDA
DATE
195
Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Value of 2� 11 Amount of
Project $ 11 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 . f .: G "7 z ( s . - 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 ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent; servant or employee.
BY AUTHORITY
DATE: J 10 v
OWNER'S NAMEgRL. PHONE 3os) -32_ai
ADDRESS;, �� NC._ 100 S*
* * * * * * ** ****************:******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: ¶ ?$ J /0 p S�
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME:
* * * * * * * * * * * * * * * * * * * * * * * * * * * *i * * * * * * * * * * * * * * * * * * * ** ** * *** * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Soffit
Roof
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
s
Flower Bins l� �
Shutters ,/. s
Awnings (,,J,4_
Chimney .e_,%/,-; � �
Doors and door jams e.��-.4 �-p
Garage Doors 1A-?-
Railings
Fences (,��
Decorative Metal 4 , ,a,( 4 _,
All brick (simulated or regular)
Stucco Banding le:(,
Any other stucco features Cam, ,7r2
Accessory Buildings ,l4-1 Z o
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
sa les.
Signature of Owner Date `< Signature of Contractor Date
g g
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED: WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Building Official Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date • / ../Q ..tv Job Address X 39 J 1 , \( ) 5* Tax Folio
Legal Description –j9, a27 Historically Designated: Yes , No
/ Tenant , r ( GkC \..) Master Permit # 9f «9'
c)‘ \. \Qo S-4c- Phone`( (.70 -ELI - T 2
Contracting Co. , (,,1(' 1 7 - e 7 Dh e Address
Qualifier SS# $ hone 60_0 p,5
State # . Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Owners Address
Mortgagor Address
Permit Type (circle on : BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION,' (X UKT7 f_)(7(21oCL Cc" 14OUSO__
) (Sign
FEES: PERMIT
APPROVED:
NOrf S
/
or ondo 13iletdilAt3 ' 1 ri T
• ARY PUBLIC'STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1 _ tk32
tur
•
or Cone= resident,
wner an
I Date
Notary : s to Owner an
My Commission Expir
g. Furthermore, I authorize the above -named contractor to do the work stated.
RADON
•
Zoning Building / / i 00lOt
Estimated Cost (value) / V /SDO
Notary as
My Co
ntractor or Owner- Builder
ontractor or
ssion Expires:
Electrical
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.
O i ' 'S AFFID , : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
con ction
ature of C
c O ,a /0'
ICIAL 14OTARY S
C:T ATW J V11 1 AR
AittlitetBLICSTATE OF FLORIDR
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR 1''.Qo2
C.C.F. /, o NOTARY ,5"
BOND
TOTAL DUE
` /8Cd
ate
' o Expo?
Mechanical 'Plumbing Structural Engineer
/ - /D- pee