PAVERSPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Legal Description
Owner / Tenant 1'Q Z;F -L � uR'vLSI�
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Owners Address /�
Contracting co o P u L
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION -ei(16-Amn ' `lam C AtAs.. € ClL G_ fut\w
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Square Ft. 17...Z. Estimated Cost (value)
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 perfonned 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 w wi on mpliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
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Tax Folio
Historically Designated: Yes No
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GARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MARL 1
Notary as ' ontract
My Commission Exp
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Plumbing
Master Permit # vg f
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Electrical
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Date
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Structural Engineer
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iLLIL 20 and ih W r75- nf Lot 21
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CHARLES W. CARR
LAND SURVEYOR
MIAMI, FLORIDA
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PATS OF PLOILIDA
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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.
MIAMI S H O R E S VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
•
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Street and Number where work is to be done
Remarks (Signed)._
Permit No
Disapproved Date
(Signed)
Burping Inspect 'br
Chairman
Member
Member
Council Approved
Date
1
-•-�- ---- -- -- �
PLANNING BOARD DATE
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No Street
,19
State work to be done and purpose of building (by floors)
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 $ v Amount of Permit $ c2
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, 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 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.
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 forego application, and that he did sign the same, and that all facts
therein by him stated are ^^
Date & 9 ° / Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections
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.
or changes to this application after approval has been obtained from