444 NE 102 St (12)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
,4 ) Job Address �� 2'OZ v':6__Tax Folio
Legal Description
Owner/Lessee / Tenant �) _ /
47 A ".� 4Le�ir P
Owner's Address �¢4 ,(,�� /e' Z S 'c
Contracting Co. c4 `;
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Qualifier
State # /1/ Municipal # Competency # Ins. Co.
Architect/Engineer / M W H!Tf Address
Mortgagor
Bonding Companw Address
iI Address
Permit Type (circle one): BUILDING' ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRII'TION o ce s �. e mot' l" �2r-� o , �- — (� rot o e t I' oGc I
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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.
1
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
e _ Historically Designated: Yes
RADON
C.C.F.
12.0b
NOTAR
Building / /r
6.1f-o� Electrical
Master Permit # 7
Estimated Cost (value) .,? 7 O0 0
Signature of Contractor or Owner- Builder
TOTAL DUE
No t/
Phone
Address ¢ /e/ ,'2' 2 S
SS# Phone 3Ac r.S'l
Date
n / :" 7 a a/C/a
otary as to Contract'bf or Owner - Builder Date
My Commission Expires:
FO
- fi r rey _ Y,Z7. s L3
P g ARIT ON EL
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pt co As N p
112, , It p ya Q CC7972
Erf cONaMISSION EXPIRES
OF f-0 DEC. 17,2002
BOND
Plumbing Structural Engineer
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Owner's Name and Address
Registered Architect andior Engineer
Name and address of licensed contractor
Location nd legal description of lot to be built on:
Lot f/f/ 10 4'T D 9lock V /
STATE OF FLORIDA
COUNTY OF DADE.
}SS.
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 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.
S lT/, /a?
Street and Number where work is to be done
State work to be done an urpose o building (by flo rs). staxterior colors (submit samples)
/ 93
Subdivision ii-MY MY f h /t 4 1/ 7 c OO 1 G"5 O 7
New Building Remodeling Addition Repairs No. i
To be constructed of Kind of foundation Roof Covering_
Estimated Total cost of improvements S /(f tr3r Amount of Permit S
j < 4
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 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 bui ding permit does hereby certify that he understands and accepts his obligatons 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 subcontractors 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 undersif o
gned�agrees�to employ only such subcontractors, on work to be performed
(SigneI `r `� or h7 Z
under this permit, as are licensed by Miami Shores Village.
Remarks U/wJ`
•
Before me, the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared
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 constrru�cti�on ,t that he has carefully read the force oin application. and that he did sign the same. and that all facts therein by him stated are true.
Permit No J f/"' lQ I Date /�< Read. Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector My Commission Expires
Date
i7
Street Jo,
2 7' 1 6tlG
Notary Public. State of Florida
;her purpose.
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 525.00 will be charged when such re•inspection is made necessary by improper notice for inspection or faulty materials andhor workmanship.