77 NE 100 St (3)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
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Legal Description c, E/y /AG it/A. 9?J ,J'.. ftr/ Q Master Permit
Lessee / Tenant /1/e_7 e. 5j /y,9.7x/
Job Address
Owner's Address
Tax Folio // 2.2,10 /3 /30
phone 7s7 ojz
Contracting Co. 19u0„&y/ Address
Qualifier SS# phone
State #
Competency#
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one BUILDIN ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost ) ,/..%T.
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.
Sign re of,Owner and /or C•1To President
Date:
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Noy as o Owner and /or Condo President
My Commission Expires: NOTARY PUBLIC. STATE OF FLORIDA
* * * M*COMMISS*BN EXPIRE*APRIL 16, *992
BONDED THRU STEMBLER4DAMS & SWEET
PERMIT FEE: APPROVED: Fire
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Plumbing
Ins. Co.
Signature of Contractor or Owner - Builder
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires:
Other
Engineering
MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT
INSTRUCTIONS TO OWNER- BUILDER
You have, this date, made application for a building permit as an owner -
builder. You should be advised of the following provisions and requirements
that apply to owner - builder.
Proof of Ownership - Prior to a building permit being issued to you,
you must submit proof of ownership of the land concerned in the
application in the form of a recorded deed, showing you own the Property,
or a copy of mortgage or warranty deed of the land, or a Dade County tax
receipt, statement to contain legal description of property and indicate
property is in your name. Legal description and name on document of proof
must correspond to the name and legal description on the application.
Responsibility - You will be responsible for all work done by your day
labor employees, and you must either employ licensed contractors or
persons to be paid on an hourly or per diem basis. Any one contracting
(including labor) with you, verbally or in writing, on a fixed fee basis
for any work, who is not properly licensed, will be subject to a fine of
$500.00 and /or imprisonment for six months.
Insurance - You should be advised that if your day labor employees cause
any damage to persons or property, or if any of your day labor employees
are injured on the job, you are liable. Your regular home insurance
policy ordinarily does not cover this type of liability.
Withholding Taxes, etc. - You should be advised to investigate your
responsibility for withholding Social Security, Federal and State
Unemployment Insurance Taxes and Federal Income Taxes from the wages
of employees working for you on the proposed construction, and for
making returns thereof to the proper agencies.
Work Permitted Owner - Builder - An owner - builder subject to the foregoing
provisions and requirements, is limited to constructing one single family
residence each year for his own use and occupancy; or maintaining, altering
or repairing his own single family residence.
If you do not intend to do the work involved yourself, or with day labor, please
list below, the name of the individual or firm with whom you have entered (or
will enter) into a contract for the work.
NOTICE: SEPARATE PERMITS REQUIRED FOR ELECTRICAL, PLUM1BING,
ROOFING AND MECHANICAL WORK
.vet 0. S
Name of Individual or Fir
I, the owner of property described as
Address
7J E /e_--o
do hereby certified
that I have read the foregoing instructions, and am aware of my responsibilities
and liabilities under my application for a building permit for construction work
on the above described property.
Witness / Owner
Date