102 NE 102 St (2)Date '< -O' Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
2 — .4 /t. /DZ ST Folio
Legal Description Historically Designated: Yes No V
Owner/Lessee / Tenant), r OE $2 / PFT:2 /-4041/ / 9 Master Permit # Y- /3 �O 7
D /y 0� C�
Owner's Address /C2 /t/6 /L77 . ST Phone f 7,5"7 e7,?
Contracting Co. Address
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
WORK DESCRIPTION EX /57 t/ hi p/ZO.¢ <,i"
Square Ft. Estimated Cost (value gf cicXj
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 zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date No
My Commission Expires: y Commission E
FEES: PERMIT O RADON
Plumbing
C.C.F.
b
.1
or Owner- Builder
rres: is Fl
GLADYS J VILLAR
N`:li'ARY FOLIC STATE OF FLORIDA
COMMISSION NO. CC7141113
MY COMMISSION EXP. MAR. 1 Z <''?
j ture . Co_ ntractor . er- Builder
soa - �76- 70-i66-
as to Contractor
NOTARY)
BOND 3 0 o
APPROVED:
Zonin e I" ' "`°�' ' Building „ I Electrical
g � g
Mechanical
TOTAL D
FENCE SIGN
Date
Structural Engineer
W
f t t k , .
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
peared
Disapproved Date
(Signed)
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.
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 -- --
Street and Number where work is to be done__ $ �� 9
State work to be done and purpose of building (by floors)__
�� >�
Pip g ( Y ) ' .. -�,
New Building Remodeling Addition
Building Inspector
Chairman
Member
Member
Council Approved_ Date
NOTE: A charge of $1.00 will be made for making
the Planning Board.
A re-inspection fee of $1.00 will be
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
PLANNING BOARD DATE
Repairs
n
,
Street # / (# `0
,
and for no other purpose.
No. of Stories
To be constructed of rr Kind of foundation _ Roof Covering
Estimated Total cost of improvements $_Sks Amount of Permit $
Zone cubage required _Plan Cubage
7 •
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 rovisions 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.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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.
Permit No.__!'n f Date t). Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
corrections or changes to this application after approval has been obtained from
charged when such re- inspection is made necessary by improper notice for inspection or faulty
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