520 NE 102 StPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date tr (3 / U ( Job Address Sao A/,C_ /O 1 .)1. "Ant. .rAuc-er Tax Folio
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Legal Description Lo7.f 9 4241,4 /0 / 8/o c.9y /14.Y An,eh4 Master Permit
Owner / Lessee /.Tenant
Owner's Addre
Contracting C
Qualifier
State
s
o
Architect /Engineer
Bonding Company
Mortgagor
PERMIT FEE: APPROVED:
Zoning
Mechanical
At- /0
b onn4. L . /L (sow
/O.Z S?` ����i J lit of i , , F L 3? /Phone 25 `/0 5
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Competency # Ins. Co.
Permit Type (circle one )):CIUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION /(emou4 Gii X /' /ace e?(tlii 1 d.1 W i -4dOkor .
Square Ft. Estimated Cost 42.2 0 0 . o o
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DC) 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 ¢o 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 Signature of Contractor or Owner - Builder
Date: cP/43/F/ Date : / /.3/,,/
4
Notary Notary as to Owner and /or Condo President
My Commission Expires: 7 /it /9y
* . * * * * *
Fire
Plumbing
Address
SS# - - Phone
Address
Address
Address
25 - 5`7 i f
[ 110 °17/060
Notary as to Contractor or Owner - Builder
My Commission Expires: 7//2/9J
* * * * * / * * *
Other
ilding ? Electrical
Engineering
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 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 L . :9/0 ,.�
Date...
Registered Architect and /or Engineer a — fk, ,,,.,,,.. :,.. ,. .,...�
Name and address of licensed contractor 1.. ..... 1 C-be.- _.... - hi -
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done a. a
State work to be done and purpose of building (by floors). � rl
and for no other purpose.
New Building Remodeling v� Addition Repairs No. of Stories
To be constructed of Kind of foundation..:: Roof Covering
Estimated Total cost of improvements $ Ic x q • Amount of Permit S. .1`,119
Zone cubage required plan Cubage
Size of Building Lot
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said buil ing. All notices with reference to the building and its construction may y
be sent to ?w �..,P�r cr.Lti' — �-/ C • / �v 77 - a 7) .... GU-e. �i7'4�r*•% �, .
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 subcontract9rs, ogwork to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. ss.
(Signed)
N
et")
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.._..__ Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Building Inspector 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 hoard.
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.
- r • e
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BUILDING
ELECTRICAL
PLUMBING
ROOFING
MIAMI SHORES VILLAGE. FLORIDA
o PERMIT N® 2472
Er
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
CONTRACTOR OR BUILDER
DATE 195
Contractor's
License No.
Work to be performed under this Permit
B1
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed- BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY