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DRIVEWAYDate I0' C i -e n‘ 7 Job Address ,(C, /YE / ©2 6:7 Tax Folio Legal Description Owner / Lessee / Tenant / /200 nai c )9' Owner's Address ‘C /1/C /02 . T Phone 75 Contracting Co. -S/,92S CC,/Z ®. Address 61500 .. W v5- sr /101 PAS Qualifier (7:5 S /'lid SS# Phone 4 7 State # Municipal # ,E ' Competency #E f Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor . Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFINGh FENCE SIGN WORK DESCRIPTION /2Ec.5 1.1/Z F 9CE EX / Ve k1// 77 On/Gc /N C / Square Ft. /.S 3 U Si: ature of owner and /or Condo President D. e • PERMIT APPLICATION FOR MIAMI SHORES VILLAGE APPROVED: Notary as :to Owner and /or: Condo President My Cbm6ission Expires: - t "4. / 2 . 3 - 7 Date: Notary as My Commis * Master Permit # 4 05 - 6° * Estimated Cost(value) // 00' 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 author' e the above -named con actor to do the work stated. A zr‘ Si nature of Oon or Owner- Builder • FF? _--- tc�- �� 1WEE er- � v , �Yto P . � STA7E OF FLORIDA io ns l ON NO. CC343861 MY COMMISSION EXP. AN. 28 1998 uilder * * ** 3 e7 TOTAL DUE y� U 3 c??D ** * * * * * * * * * * FEES: PERMIT NO. RADON C.C.F. G NOTARY Fire Other Zoning Buildings PIM Electrical Mechanical Plumbing Engineerin 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. � Xa J ‘P--/.7 , 19 j � Owner's Name and Address.... `f' ° '° No () / Street Registered Architect and /or Engineer � � ^'�- -/7` Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors)__ STATE OF FLORIDA, COUNTY OF DADE, j ss Disapproved _____________ Date (Signed) c _ Bus • ng nspec ■ Remarks (Signed) _.and for noy6)fser purpose. New Building Remodeling Addition Repairs No. of Stories VV To be constructed of Kind of founflation Roof Covering 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 ublic notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wor be performe., under this permit, as are licensed by Miami Shores Village. 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 -lo_7 Date ¢ -' 9 -67 Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires ANNING 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. ,c , 1