210 NE 102 St (13)PERMIT APPLICATION FOR MUNICIPALITIES
(OWNER TO RETAIN COPY)
Date 7-2-3-9( Job Address a / 0 /✓E 10 ? ij°° 51) Tax
Legal Description
Owner / Lessee / Tenant
Owner's Address (, // JO 7- W & S /
Contracting Co. 69
Qualifier (/lam' "f 5 fi
Stated (& IC. /5 . 3). Y
4rchitect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SI
WORK DESCRIPTION e/246 x 1 � /-or, SJ�4 -7 X1 L► r✓i
r e .-% 14 /vi t 7;e3, Meal
Square Ft. Estimated Cost , V. U 0c'7
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE '
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF Yt
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF CEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, a
on the attached addendum (if applicable). I certify that all work will be performed to meet t.
standards of all laws regulating construction in this jurisdiction. I understand that separa
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT": I certify that "all the foregoing information is accure and that all wo:
will be done compliance with all applicable laws ing ruction and zonin;
Furthermore, I authorize the above -named contractor to d
Sign ture of
Date:
Notary { as to O:vner d /or
!iy_ COnni =ss :i on, - Expires:
*- *. ..* *
•
PERMIT FEE: APPROVED:
Zoning
echanical $
�L a
er anh/or Condo President
1!5 /9
"Condo President
Address
SS#
Competency# Ins. Co.
Address
Address
Address
} _lumbing
Master
Building Electrical
OF DADE COUNTY
Folio��.�o��ly d0/
Permit. # ra 95
Phone 7 5 f -212 7
Phone 07/ 3L y
Notary as - to Contractor or Owner -B *.tildes
NOTARY PUBLIC STATE OF ORIDA. My Commission Exp f iY PUDLIC, TATE of FJ;ORIDA,
MY AMMISSIO XPIRES: ril 1, 1995. MY C (MISSION FIRES: A111L11 I, I9S
BONDED THRU NOTARY PUBLIC UNDERWRITER BONDED THRU NOTARY•PUi1JC UNORRIVRJTRAgh
Fire Other
Engineering
STATE OF FLORIDA, 1 .
COUNTY OF DADE.
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ut 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 .....f 1` t...... J t
Registered Architect and /or Engincet �!'�,,i�l�r
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done... :.j
State work to'be done and purpose of building (.by floors
/ 24
Subdivision
Chairman
Member
Member.. ... _....._..._._ ...._......
Council Approved Date Disapproved
Date..._..._..._. -' 1._...,/_�... »._._.... »... ,19.��'
— No ... .... ....... Street —..
Afina
geared
Notary Public, State of Florida
My Commiuion Expires _...._
PLANNING BOARD DATE
NOTE: A charge of $1.00 will be made for making corrections or changes to this application After approval
the Phoning llo.►rd.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice
materials anti /or workmanship.
and for no other purpose.
No of Stories
Covering
New Building / Remodeling Addition Repairs
To be constructed of Kind of ou dation y
Estimated Total cost of improvements $ /v} Amount of Permit $.i
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 Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied ss ith 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 are required by the Act. The undersigned agrees to employ only such subcontractors, o 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 authorizcd to administer oaths and take acknowledgments, personally ap-
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 true..
Permit No.. , �L 4 11..! Dat/ Read, Sworn to and Subscribed before me.
Disapproved .. � y ^ Date — 7
(Signed)
Member
Member
Member —
to me well known,
Date
has been obtained from
for inspectirm or faulty