61 NE 102 St (13)Date
APPROVED:
9'
Legal Description
Owner / Lessee
Owner's Address
Contracting Co.
Qualifier
State #
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 6/ N• -• ! b e -n
/ Tenant LR.2 - d � ' ;TV . Master Permit # 3%
50 1 !" / DV1 D - rneL - r - , Attti shtiezi.RvitlA Phone 17--2 J
Ow,vtn
,0/A_
Municipal #
* * *
SS#
Tax Folio
Address i4 i A-S -
- - Phone
Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAV
in b nk fic & �� a �2d '142"(
Square Ft. Estimated Cost(value)
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 applicabl- laws regulating constructio nd zoning. Furt rmore, I
aut . ize the abov arced contractor to the work state
Sig ture of owner an or Condo Pre nt
Da
Notary as to Owner and /or Condo President
My Commission Expires:
*
FEES: PERMIT C < O. RADON C.C.F. /6-0
Fire
Zoning Buildin
Mechanical Plumbin
SIGN
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Si
Da
Notar
My Co
NOTARY g":
xPARINA:Rf3 GTONTIEL
C00.3 ∎ISSION NUPaDl R
CC4O12 1
%Qv CONNISSION .Ic P.
U. 17- 1, ,_
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ilder
- Builder
/c26
* **
TOTAL DUE
Other
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.
t
/ Date ` �J/ /_ , 19f�
Owner's Name and Address__ �t ____�__t_ ' �c s'' _ f t No l // ` Street__- / g' -
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on: SP
Lot___ __ __2 5-- Jo 2Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors
,7
Distance to next nearest building
and for no other purpose.
New Building Remodeling Addition X Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ / fc — Amount of Permit $
Zone cubage required plan Cubage
_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 public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco tractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks--------------------------------------------------------------------------- - - - - -- (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 f Date! Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
( Signed) ti Al !_�-
- Building Inspector My Commission Expires
to me well known,
PLANNING'l3OARD 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.
Company
Job
Date Ready
REQUEST FOR INSPECTION
e c
Address ,L■0": •.-
Inspection 6//i
Time Ready
PHONE
A.M. P.M.
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