38 NE 102 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job AddressL 3 8 /1 /Q Z S1 Tax Folio
Legal Description /j Historically Designated: Yes No
Owner/Lessee / Tenant / t t aA d. OC,. fi `h `� Master Permit # p e
V
Owner's Address Phone 3Q5" - 7 9 •` /'
Contracting Co. 0 \ L Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one)�ILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION k IOrp uvto': r`Px,vt- � Cc rv- .1 ('► le_ if29Q F Glt j po 'f 54GLr c7
( /pv- C t/7L 1 {P) mtjuji `'� 4
Square Ft. Estimated Cost (value) 4 4 Q 9*9
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 Signatur
Orse—rrit
ate 1 5
C NOTARY R .40/ 1)0 2000
Notary as to Owner and/or Condo President Date No =. ': to ontra.ft �" ,I.E OF FLORIDA Date
My Commission Expires: ' Commission Evires:COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
FEES: PERMTTO RADON C.C.F. NOTARY BOND
APPROVED: TOTAL DUE s `
Zoning Building ' t Electrical
Mechanical Plumbing Structural Engineer
Street and Number where work is to be done
1 3 yo G /3 ')' F
MIAMI SHORES VILLAGE S Cb
BUILDING INSPECTION DEPARTMENT 1 d I. / C
APPLICATION FOR BUILDING PERMIT g L / /
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 du 'ng progress of the work.
Date , 19__
' No - P AV' /0
Owner's Name and Address e__a
Registered Architect and /or Engineer �9
Name and address of licensed contractor_ /O __ES �O �
Location and legal description of lot to be built on: '
Lot Block Subdivision
A; e /0 a"
State work to be done and purpose of buildin (by floors ) _
and for no other purpose.
Repairs No. of Stories___
Roof Covering
New Building Remodeling Addition
To be constructed of Kind o foundation
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 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 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 f$igned)
/y x GG'f`
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared -
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.
{ p
Permit No 0 s 43 -! Date _�9)
Disapproved Date
(Signed) y
Building Inspector
to me well known,
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved 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 such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.