1200 NE 102 St (14)PERMIT APPLICATION FOR MUNICIPALITIES O'•JADE COUNTY
(OWNER TO RETAIN COPY)
Date Job Address 121:1)0 U G 1c) Tax Folio / J2Q$ 4.5 -eaQ
M t , F1 ,33135
Legal Description Lci 1, ?Lock_ 1�S �3a` -i l�v�✓��� S � E aov Master Permit #
MIQWy ShoV Cat S \ \ c2
/ Lessee / Tenant NA,
(a- IY\ ka ?F C vv s-E�
Owner's Address 1200 IV E ( 02. 5+ lla, SlnoveS Phone , S4 �I 1 19
F 33 1 315
Address 1 SUJ g S* Fj- Lek,t4 333(2_
Contracting Co. J(e. Lt.) 11 so
Qualifier A IL) (�j,I SS // - Phone - 1(=1 - 3 - 1c11-
,/' 0.0u "� Cam A-4
State /k L� c--cp 6 89 - I139 Ins. Co.
Architect /Engineer
Bonding Company
Mortgagor
WORK DESCRIPTION
1rY4 l_d'./i
Si of Owner an or Condo President
Dace:
A. 113 a.�k��y
Zoning
Pc 4 o
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL
.0w► M��
Notary as to Ow and /or Condo President Notary as to Contractor
My Commission Expires: 1TA NBL W0tTr„romotrIAAWROAARC,Cy Commission Expires:'!
:k * * * cotkimM1SSif.*"....'.:, -1*1 27, 1981* �k * �k
PERMIT FEE: APPROVED: Fire Other
Building �j• 2g• i
Signature of Con
Date:
Electrical
Mechanical Plumbing Engineering
oT v� fie✓ �oc �L:v.c�
FENCE SIGN
Pa �lev s
5 5
Square Ft. Estimated Cost #'3,100
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.
-•u1 er
a olaner- Builder
flPd8IJC, STATE OF FLORIDA AT LARGL
IFICOMMISSIONEXPIRFS APRIL *19(11
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Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statv,sn•nt or the plans and specifications herewith submitted for the build •
inc 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 ..... t .....: f ,... °M M 1-.riL:..._. No...... _.. Street._.. _.... _
Registered Architect and /or Engineer .<.•••:,...,,. „ „,,......„
Name and address of licensed contactor 1 - ( A± . nvi.1.. -1. _/ ._ �..)..11 /v41) /..2 ..00
Location and legal description of lot to be built on: 1_0,11.4
Lot Tilock Subdivision. ._
Street and Number where work is to be done .. ..�.A.Q(... y.._.. rQ..t.?i. . ....... .._.._,. .. ...._..�._ —
State work to be done and purpose of building (by floors).......11:.::d2ll:� ..)- 1r!4.4/ td 4/.. ,.xsL ... .(1, 1 4 4
1 4t!1! 14 .e./!N” pr. _ 4 .4 y ... ...eF y .6“,eziiB.r . x .4....
SFr% a -0/Ao e.-e.. ._ ... .. n.n c -.,5 4(/.L7-2 _ ' .gefonli
New Building Remodeling Addition Repairs ,t/' No. of Stories —
Date.
To be constructed of Kind of foundation. 2 ., oof Covering
Estimated Total cost of improvements $ 76... Amount of Permit L...!✓' 00
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 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 Sup Clement,
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 noticcs as arc 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)
STATE OF FLORIDA, 1 .
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..
Permit No. 1 ( te E t Date h14, Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires _ ».. e....._.._.■■••■..._._.
PLANNING BOARD DATE
Ciiair:nan Member
Member Member
Member ..... Member —
Council Approved Date Disapproved Date
NOTE: A charge of 51.00 will be made for making corrections or changes to this application after approval has been obtained from
the Plannir.g Board.
A reinspe•ction 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.
JOB:
BUILDING
ELECTRICAL
PLUMBING
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The following is ready for Inspection:
Inspector's Report:
WORK
DONE BY:
: : REQUESTED
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JOB: t
BUILDING
ELECTRICAL
PLUMBING
Inspector's Roport: -
WORK
DONE BY:
The following is ready for Inspection:
AD: / 6 /1
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