560 NE 102 St (10)0
4-44 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date J 42 " 0I Jo b Address S 0 /(/ E /0 a- Tax Folio 1 t 3 a 0 6 oil / O 1 0
Legal Description r) rn b t v ks S p �- ( R- Historically Designated: Yes No
L 6wner/Lessee / Tenant < k / e f in 4- 5 7 fe Master Permit # l a b 6
Woi? k
Owners Address 6 400 N 6 /0 d Phone 3 6J 3,19&.3 a a )
3 05 -7 T ,3'a "5
Contracting Co. CD 1 n) 1\' ` 1
Notary as to Owner and/or Condo President • ate
My Commission Expires:
Zoning
Mechanical
, OY PO ILEANA ALONSO
i �j I 'Gr,Commission # CC 743495
y �. „cf.- Expires BONDED THR0 002
O F F " ATI.ANTIC BONDING CO., INC
FEES: PERMIT / ( RADON
APPROVED: - 1,\% e¢'
r+
YA-7/
6o
SS#
Address
Phone
Qualifier
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION LL-. 1 E $ te- r 1 0 ` i7 rj t c- 5 e
Square Ft. Estimated Cost (value) / 0 a C7
/ -o 'G
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. F ermore, I authorize the abov - . . contractor to do the work stated.
Signature of Contractor or Owner- Builder Date
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
NOTARY �' Q BOND
TOTAL DUE Q 6 0
Building Electrical
Plumbing Structural Engineer
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
i
DATE: 5 ��
OWNER'S : Ja. c y u, e ' E (1 (4-s 4e,2YHONE : 3 of 7 S-6, e,2_ ( S
ADDRESS: S (oo. /V & . )v a-- Ste.. 3,0 3001/ (4/
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE:5T 0 n^ . C. l P
CONTRACTOR & LICENSE (if applicable) 1'4"
COMPANY NAME: PHONE:
*************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site must be listed and indicate the color to be painted.
Walls nh 51 i( h e 1 1 e It a 1 cp a _c, 0 ..
•
Y
APPROVED:
Building Offi
Fascia
Soffit
Roof
Flower Bins
Shutters
Awnings
Chimney
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regular)
Stucco Banding
Any other stucco features
Accessory Buildings
Other \IV % v; rdo vL'
3 /G )- 7
Date
ash b7�
ao - s (fe)
.J
0
0
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
pies.
e of Owner Date Signature of Contractor Date
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
mystic beige
***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
) ett/2
•
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.
wner's Name and Address
Registered Architect andior Engineer
(Name and address of licensed contractor
Location and 1 gal description of lot to be built on: /
Lot Block f4 Subdivision /! �/L{' g, 'N4 �J Q di // `mod" !j
de /7 /$O f
1 tfeet and Number where work is to be done (.5 ' "E /0 5 J „ / //! 4?/0' (....C4 5 33) 3
-8tate work to be done anndd urpose of building (by floors). state exterior colors (submit samples)
V "1:///t jhi'vLN'l/ -6 / ' / /
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
�stimated Total cost of improvements S 7 `'Amount of Permit $ 7
Zone cubage required Plan Cubage
Distance to next nearest building 7 _Size of Building Lot
n
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for sail
The undersigned applicant for this building 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 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)
•
STATE OF FLORIDA
COUNTY OF DADE.
Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared
to me well known.
} SS.
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. 2 1 / Date
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
/% /D 2 -5/ , s4"--J ,6 E
Date
reference to the building and its construction may be sent to
Read. Sworn to and Subscribed before me.
Date � 19 9e
No. Street
Notary Public. State of Florida
Building Inspector My Commission Expires
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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and workmanship.