118 NE 102 St (9)Date g&/// (( Job Address // 4/c, /OR SrTax Folio
Legal Description � -
Owner / Lessee / Tenant C2rY� /(� Master Permit # .367 -1')
Owner's Address
Contracting Co. 4d1/77/'(9 , / a ddress 9 f 5 ' /3,42 c -T
Qualifier V (i), .= Phone
State # O 7ty'Iunicipal # 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
Square Ft. Estimated Cost(value) //yet)
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 F , I
authorize the above -named contractor to do the work stated.
/( t1—&
Signature of owner and /or Condo President Signatu
Date: Date:
,ecuitAa ce)A4/4
Notary as to Owner
My Commission Expi
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Zonin
Mechanical
l/ 8 4A-- /c9 s •r
// y //
P .. PUS • IC �• ' - EAL
< BARBARA ANN FUGAZZI
; * COMMISSION NUMBER
N, ''e Q CC360191
** * * � r Q ° *MY COMMISSION EXP.
F- MAR. 9 '8
FEES: PERMIT RADON C.C.F. /,
APPROVED: Fire
Building
L i - Plumbing
Phone
4! /
'rac o or 1 er- Builder
r/.?a/sy
wIw� - . �,,, _.
' PU OFFIC • a� MEAL 2
Vp� BARBARA ANN FUGAZZI
` (i 1 ; * COMMISSION NUMBER
N Q CC360191
OF w 4- 401Y COMMISSION P. MAR. ,29199
Notary as to Cont
My Commission Exp
NOTARY S , TOTAL DUE
Other
Electrical
Engineering
7.
MIAMI SH
- 'BUILDING INSPECTION DEPARTMENT
APPL CA11ON FOR
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 he 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.
Lot. AZ e z /- Block /?-- Subdivision Location and lcr i description of lot to be built on.. /16
Y
Street and Number where work is to be done / /E__N
State work to be done a d purpose of building (by floors) '" -
To be constructed of ..._ .
Remarks.
Permit No J.
Disapproved
(Signed)
Date
Date
13ui1 mg Inspecto
Chairman
Member
\temp.. r . .
Council Approval ...__ ... Date
L ES VOLL
z_
WI a fi
UILD0NG PE > MOT
Remodeling Addition
Date. — ��-
No.. J /
Kind of foundation
Q 0 200 'S'ex"
-/ i'� //�'yJ
and for no other purpose.
Repairs No. of Stories
Estimated Total cost of improvements $ Amount of Permit $.
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 su it a plans and spe ' aliens, for sai bu ing. Al l notices with r ference to the building and its stru ion may
be sent to. _ . � s e2l�i �` o�
....
n/,: /-5" e-r / /
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 Supplem
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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontracto s on work to be �erform ttder this
rm
peit, as are licensed by Miami Shores Village. `-7' ' ) � ' `y/ //
STATE OF FLORIDA,
COUNTY OF DADE. # ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persortally ap-
peared
to me well known,
znd 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.
1 C : ' — Z ? Read, Sworn to and Subscribed before me.
' j' NING BOARD DATE
Member
Member
Member
Disapproved
corrections or changes to this application after approval
NO E: A charge of $1.00 will be made for making
the P,.innin;. Board.
A re- ir,,pec•ticn foe of 51.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
�J �/ 19
(! ^ N street. �F' 1 002
Roof Covering
Notary Public, State of Florida
My Commission Expires
Date
has been obtained from
for inspection or faulty