MECHANICALDate
Legal Description �i
/ Lessee / Tenant 5 A/c I2 C/rit/ / . /C Master Permit # ?7 L
Owner's Address 40 "./. . / /c' a 57 Phone 73'4 - Lid d / /
Contracting c.,4/ £ e ,1 �/G J 'c. Address � • Q./ o 7D' c 79 A
J - �
� /o7S 5'0 SC7.5
State 06i7(: 145 nicipal # Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDI ELECTRICAL PLUMB t G MECHANICAL OOFING PAVING FENCE SIGN
WORK DESCRIPTION /3 C- Led.vr
Square Pt. Estimated Cost(value) J 2 / /c'7
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 cons uction and zoning. Furthermore, I
autho i ,' the above med contra or to do the work state• ..... ignature of Contractor or Owner- Builder
Date:
Notary as to
My Commission
** *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
c 7S ^ Job Address 60 Ai f . /OA 5 -77 Tax Folio
6 C igna ure of owner and /or Condo President
Datet
RI
8t CG78ftdinPft4Bint
totm Ins
2
1 Pv oxMy Known
No. CC28353 I. o.
* *
•
..
Notary as to
My Commission
1,6ot
Service Ins
No. LC283532
°rrsomlP irnorn j 1 !r1.b L U.
* * * * * * * * **
FEES: PERMIT L '12, 7-5
RADON C.C.F. I - CO NOTARY TOTAL DUE 50. °).
Fire Other
Zonin: Ofill Building Electrical
Mechanics /. 1 Plumbing Engineering
if
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.
Registered Architect and /or Engineer
Name and address of licensed contractor o
cam,
Location and legal description of lot to be built on:
Lot 4 - Block 1 Subdivision .. `
Street and Number where work is to be done ' .._ /0 Z
State w rk t bq a done and purpose of build' g (by fl s)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of 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 pennit 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 fo -' spection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only sue • sub y fitract9rs, on work/ to ,be 'performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signe
STATE OF FLORIDA,
COUNTY OF DADE. I ss
BUILDING INSPECTION DEPARTMENT
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Before me, the undersigned authority,
peared
_.. ........ .... _ to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
therein by hin stated are true. 1 , t . f,
Permit No. _._ Z�' � Date
e
Disapprov d /jDat
(Signed)
of the above escribed construction, that upon
has carefully read the foregoing application, and that he did sign the same, and that all facts
11
Chairman
Member
Member
--icil Approved Date
Dat e..._._. /3-
, I9.C� f
No t:1 D Street_e /02
Roof Coverin
/
a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Irllsp� My Commission Expires
LANNING BOARD DATE
Member
Member
Member
Disapproved Date
`TE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
- , g Board.
_ ection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
• workmanship.