525 NE 101 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address .5 /ilE /0 / St Tax Folio
Legal Description J/, /� &) � Historically Designated: Yes No
• Owner/Lessee / Tenant 61l1 &Y' " btC ry14 / . / It'
Master Permit #
Owner's Address .5 2S A / 0 / Phone 6.0 732 o2 91.Z.
Contracting Co. A 11 — OW /1 Y Address
Qualifier SS#
State # Municipal # Compete },
Architect/Engineer Address 4
Bonding Company
v`r Address
Mortgagor /CJ _ Address
Signature of owner and/or Condo President Date
Ph.a,P
Square Ft Estimated Cost (value) -A -P
Date
Permit Type (circle on : BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION � l 1 %� 1 fa" /11 t ° / Tom — a Ad e_
°t_
-fr; n ) _ J
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
r 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.
Signature of Contractor or Owner- Builder
c'/ 37- 7S0-0
- 7 , 7707 -- 1 / y',„P
Notary as to Owner and/or Condo President Date ldotary as to tr : ��` ±wii Bisi}deK.,
My Commission Expires: My Comrcu ,, }; . ;.r� I
! MY C•OM+! '
FEES: PERMIT 77/ RADON C.C.F. NOTARY BOND
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
Date
TOTAL DUE
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date a -1-
1- 7 / " y�Job Address
Legal Description
/ Lessee / Tenant P/ fA 7 i a Co,46rv'
S
G r
L
6
Own er's Address 02 6 N `.,C� � /
Contracting Co. Address
Qualifier o 6 SS #- Phone 7 7 O i r 7
State eae 0° Municipal # Competency #
Architect /Engineer i /
Bonding Company Z% F `
Address
Address
Mortgagor Address
Permit Type(circle one):( BUILDING
0
WORK DESCRIPTION , 2' / 6/es' /Ii / Nr1
�} T7c c '
Square Ft.
WARNING TO OWNER:
SO MAY RESULT IN YO
TO OBTAIN FINANCING
NOTICE OF COMMENCE}
Application is hereby
on the attached addend
standards of all laws _
permits are required for ELECTRICAL,
OWNER'S AFFIDAVIT: I certify that all the foregoing informatio
be done in compliance with all applicable laws regulating con
authorize the above -named contractor to do the work stated.
xcinvA, P
Signature of own'r and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires: V
*
ELECTRICAL PLUMBING MECHANICAL
VICE OF COMMENCEMENT AND YOUR FAILURE TO DO
MPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
• -LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
to do work and installation as indicated above, and
:ertify that all work will be performed to meet the
in this jurisdiction. I understand that separate
PLUrwirmi, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
*
Tax Folio
Estimated Cost value °' ci" 4) /'
Master Permit #
Phone
Ins.Co.
ROOFING PAVING FENCE SIGN
la /"L 5"a T L -
is accurate and that all work will
ruction and zoning. 'Irthermore, I
Signature g( Contractor or er- Builder
Date:
CG
/// / /._, i it /`///.it
Notary as to Contractor or Owner -Btu er
My Commission Expires:
NOTARY PUBLIC, STATE OF FLORIDA.
* * D J Y COMMnSSION IEVIRES: Dec. 29, L995
MIRED THL NOTARY UBLIC UNSERWRITE
6 RADON C.C.F. l+b4 NOTARY TOTAL DUE
Fire
Zoning Buildin
Mechanical Plumbing Engineering
Other
Electrical
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 / l a t t t i L n /ti S
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot / 7 'I W a / Block I ij
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Subdivision ,M-
Street and Number where work is to be done
State work to be done and purpose of building (by floors), state exterior colors (submit samples) EX r r
Date r / 19
No. $ r r" F. Street /0 / •
(fa / 7 / //#
• CC ;/71;/ta
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
Tb be constructed of AAww Kind of foundation Roof Covering
Estimated Total cost of improvements S 4�r/: Amount of Permit S .> /C
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 plans and specifications for said be reference to the building and its construction may be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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. �y(
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared
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 foregoing application, and that he did sign the same. and that all facts therein by him stated are true.
�(I
Permit No. �9 Date "? �' Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved ate Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
Notary Public, State of Florida