350 NE 101 St (13)My Commission expires
Chairma
Member
Member
Secretary
Building Inspector
BUILDING PERMIT RECORD
MIAMI SHORES VILLAGE
.FLORIDA
Permit No..2 r,� Issued t
Electrical Permit No.
•
Signed 41
DATE
APPLICATION
Appl'ication Is hereby made for the approval of the plans and
specifications= herei•pith, submitted for tha building or other
struetuhe=herei'n described. This a•npilcai1on is ;grade in com-
pliance anc! conforma41
Miami Shd"�es Florida, add all d prov provisions the Laws of the State of Florida, all Ordinances of Miami. Shores
Village, and all rules and re3ulations of the building .
Department of Miami Sho.e& Vi.11age, shall be complied with,
whether "specified or n t.
OWNER '
•
ARCHITECT / , � � ' , ' - _ g?ti r Jr< 4 , ; L / CONTRACTOH
LOT _ 'LK f SU3DiVISI �E1 �d: . � � r f
E 1
NEW /ADDITION REPAIRS NUMBER OF STORIES / ROOF / ' � • i
m.rl - 1" � ' F
COST (excluding Architect's fee, landscapin 6 & t ~
g garage) -
Building to be used for /,c_' I and no other use.
I hereby submit all the plans and specifications for said
building'.
STATE OF FLORIDA)
COUNTY OF DADE )
Before me, the undersigned authority, a notary public, duly
authorized to administer oaths and take acknowledgment,
personally appeared to me well
known, and who, being by me first duly sr; crn, upon oath
deposes and says that he is the builder of the above described
construction, that he has read the foregoing application,
and that he did sign the same, and that facts stated by him
are true. Read, Sworn and Subscribed before me,
Notary Public (Signed)
Cubic feet required in tI}is Block��, 4'!'
GL-L[it
NNING
RD
Date
„
Plumbing Permit No.
Plastering
Lathing
Electrical
- Mason 8a . Concrete
. Plumbing
Roofing
LIST 0
•
SUB-CONTRACTORS
�iILJa_.
Painting
i
■
Glazing AMPM
IMIrjrf
Miscellaneous
Date , Tax Folio
' T 7
Legal Description '"� ° ` N � 12 t hst orically Designated: Yes
?4, CO c.. Q <' . Master ( Permit # 4/ f (21 /
/
v
� 3�So � . �' ‘,0 (s � �� l - 030q
Owner's Address Phone I /
Owner/Lessee / Tenant
Contracting Co. Address
Qualifier SS#
State # —� Municipal # . — Competency #
Architect/Engineer Address
Bonding Company - Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRI AL PLUMBING MECHANICAL ROOF
WORK DESCRIPTION e,;
Square Ft.
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
061 1 3101 job Address ..350 (1.t. 101 .911b64 4
X30
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 • • u ermore, I authorize the above -named contractor to do the work stated.
06 9 a .Q.,
Signa e o owner and/or Condo President Date Signature of Contractor or Owner- Builder Date
..P L. .W tower 2 ✓ ri z 3 , 6f6 44 - 796 .
FEES: PERMIT (QD RADON
Estimated Cost (value)
O /31e7
Date / Notary as to Contractor or Owner - Builder
My Commission Expires:
OFFICIAL NOTARY SEAL
RAQUEL HERNANDEZ BERNAL
NOTARY PUBLIC STATE OF FLORIDA
C.C.F C 4 OM — MY - COMMISSION S
; 6 a
Electrical
Phone
Ins. Co.
Date
BOND 3 0
/ Q Q
TOTAL DUE 3 (0
Plumbing Structural Engineer
PERMIT NO. •
ADDRESS: .
MIAMI SHORES VILLAGE
BUILDING / ZONING DEPARTMENT •
SECTION
BY
DATE
ZONING
ELECTRICAL •
MECHANICAL
PLUMBING
FIRE
PUBLIC WORKS
STRUCTURAL
BUILDING OFFICIAL
1. Sub to cc■apfanos with it Federal,
Coctty,Waga (Vas rid regulations.
no responsibility for ac urecy of(oc
these flans.
State.
Waage asst
restatts fco a
2. This copy of plans mutt be ariilabte on
buffeting site or no Inspection will be coctdected.
JOB ADDRESS
CRITIQUE SHEET
APPLICANT
PHONE If
APPLICATION
SHEET OF
MISCELLANEOUS
DATE
COMMENTS INITIALS
Lot
Tax Folio #:
WHEREAS,
following described property:
Legal description /folio #:
requests permission to install:
COVENANT OF C
(owner
Block
[ ] Asphalt
[ ] Landscaping
[ ] Other
brick pavers
within the public road right of way of
SIGNED, SEALED, EXECUTED AND ACKN
SIGNED. SEALED AND DELIVERED in the presence of:
M iami ShoreJ
10050 N.E. SECOND AVE.
MIAMI SHORES. FLORIDA 33138 -2382
Telephone: (305) 795 - 2207
Fax: (3051756 -8972
STRUCTION WITHIN RIGHT OF WAY
, hereinafter referred to as the Owner of the
Subdivision
pRluECuAY
P PR o,'1-ct-f
(address)
IN CONSIDERATION of the approval of this permit by the Village, the Owner agrees as fellows:
1. 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 re entative).
n this
owner