160 NE 102 St (13)Signat
Date : 7,j
Date
Legal Description 2 V / 1* :/72�7 j
Owner / Lessee / Tenant �b5 �h CES�ro {( Master Permit ��✓✓ �/O(
Owner's Address 1( t'JE 2 _ Sf r►1 l� v ' Skov (F6 3j13 'hone 7 2-z ra.
Contracting Co. L,L)' U i erok cr Q �Adar �C?l7 - ° a'Z?� f? YY7I2) Fy33025
Qualifier
State # Municipal
Architect /Engineer.
Bonding Company
Mortgagor
Permit Type(circle one):�LDIING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION �rQSS�cre-
P ��-
Square Ft. Estimated Cost(value)
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 - c,-d contractor to do the work stated.
N•f ary a- to Owner a
M Couanission Expire
** *
APPROVED:
*
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
owner and /or Condo President
9.3
*
Zoning
Job Address J/ 12€ /t Tax Folio // 5 O 43 /(lit
/96
*
*
Mechanical
SS# - - Phone o4 43 Z7
Competency # l899 '' " %s.Go.
Address
Address
Address
�(ea h l � , �a ;, r, S c d p& r
J P (iOe Ili i 1J?/J-&
Signatu r� 4 Contractor or Owner- Builder
Date:
rte:•" ;, : JOSEPHINE CHURCH
i ..., ii /. -1 -'ice., j sNotar -
�.�r
tar; as to Con u r�GMll�lallfaMl
My Commission Ex • r .. :.,/
FEES: PERMITL7 75?' RADON C.C.F. NOTARY .6t1 TOTAL DUE
* * * * * * **
Fire
uildii :tI Iyam 1. Electrical
Plumbing Engineering
Other
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 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 regula-
tions 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
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Block / / ____ Subdivision 14 4 4 4-1/ 1 ./' 4-
4 .
L . No
p
..w.� 1, _0 —
Disapproved _________________ Date
(Signed)
Building Inspector My Commission Expires
Date_ r— -
19
i
and for no other purpose.
New Remodeling__________ Addition_ Repairs � No. of Stories_____________
To be constructed of_____— _________ Kind of foundation Roof Covering_
Estimated Total cost of improvements $ "'J / - 1 •C •' 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 submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
Notary Public, State of Florida
The undersigned applicant for this building permit does hereby certify that be 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.
Remarks (Signed) L4
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
PLANNING BOARD_ DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
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 ue.
Permit No � Date / / ' Read, Sworn to and Subscribed before me.
__Date
NOTE: A charge of $1.00 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 $1.00 will be charged when sucb re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.