565 NE 101 St (10)Legal Description Lod' 2.1 4 12 t B 1 K 9 1 c IM►avti t 5kaA.cs Master Permit #
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/ Lessee / Tenant
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Owner's Address 56 s A �,1w 1 o L 51- •
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Contracting Co. 1 • r
Dk l n rl ckko L Address 7 It3E t.)% Si- •
Qualifier �V o6ev4 kohl( SS# Phone 75e-4'144
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date 1 Job Address S4.5 rJ 3 , ) Ot S-}.
State #
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle
WORK DESCRIPTION
Square Ft.
Signature of Owner and/or C do President
Date:
Notary as to Owner
My Commission Expires:
* . * . * *
PERMIT FEE: APPROVED:
goo
"VA-
Competency 75.7 3 89 -O Ins. Co. lAGtrrikvxci l�u� t Oo •
Address
Address
Address
one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
Z ?CIn Z . _At l t c
•1 r ve .
Notary Public State of Florida
My Commission Expires 9/18/92
Bonded Thrii Stemh1Pr -Atom R. Sweet
and /or Condo President
Fire
Zoning Building
Mechanical Plumbing
Estimated Cost
Tax Folio
Phone 7 s4 -4 1 ,
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TOt/
1 #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.
t ilOWNER'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 work stated.
e of Contrac
Other
Electrical
Engineering
4 °°
creiveippiimisisiegt Florida
My Commission Expires 9/18/92
Bonded Thru Stembter,Adams & Sweet
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * *
* * *
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PERMIT 1#3 I 1.1 4 - f = Tax Folio No. 11 320( t7 1140 8"
• NOTICE OF COMMENCEMENT
State of Florida
County of Dade
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following
information is provided in this Notice of Commencement.
1. Description of property: (legal description of the property, and street address if
available) 21 Z Z l� l k e l ✓v4 I cum; St, me c_r oa 4
D . General description of improvement: l2 2q 2 t 1"7. rivcwo∎Vrt c����avr,�S,
3. Owner information:
a. Name and. Address: �otp ln u ,���
b. Interest in property: O fA.9 1►1 e-A
c. Name and address of fee simple titleholder(if other than owner):
4. Contractor: (name and address)
5. Surety:
a. Name and Address
b. Amount of bond$
3 . Lender: (name and address) to /fl
7 . Persons with the State of Florida designated by. Owner upon . whom notices or
other documents may be served as provided by Section 713.13(1)(a)7., Florida
Statutes: (name and address)
3. In addition to himself, Owner designates _ of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),
Florida Statutes.
). Expiration date of notice of commencement (the expiration date is 1 year from
the date of recording unle + ss _ ] a different date is specified)
%
otary Public
e ookCloks 4,rinSid 15-4•J C._ 79 131= 1115 -t.
STATE OF FLORIDA
COUNTY OF DADE
I HEREBY CERTIFY that this Is a t e y of The
original filed in this office on ef A± , A D 19
WITNESS my hand and Official Seal.
9 1R 183728 1991 JUN 03 12:05
51„ S /J.E . 1 0 1 .J."t' . 1 ■60■^■ S1
L �G ,ate
Signature of Own
,worn to and subscribed before me this day of av" , 1991.
flotary Public State of Florida
My Commission Expires 9/18/92
Bonded Thru Sternbler•Adarns & Sweet
My Commission Expires:
33 IL, t
MIAMI SHORES 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.
Estimated Total cost of improvements $
Zone cubage required
Disappro
(Signed)
spe
ate
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 Subdivisio
Street and Number where work is to be done
State work to be done and purpose of building (by floors
Permit No Date
Chairman
Member
Member
Council Approved 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
materials and /or workmanship.
Date.
No � Street /0/
New Building Remodeling Addition Repairs No. of Stories
Remarks (Signed)
�►j
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
aqd for no of er purpose.
To be constructed of Kind of foundation Roof Covering
t.R'
Amount of Permit $
_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 permit 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, p
COUNTY OF DADE. J 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 foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
or changes to this application after approval has been obtained from
when such re inspection is made necessary by improper notice for inspection or faulty
S
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