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PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date g Job Address '74Q NE / 0a St Tax Folio 1] 33 - N o - 0 f -) 4 (0 0 Le Description 50C 1 14/14 0 Pb )()-70 it/4 Q r hstorically Designated: Yes No , Owner/Lessee / Tenant , )2(42 (J V vale/ Q. cr ,Q41 /1 f Master Permit # Owner's Address 3`15 /vg / 00 . Contracting Co. () \/t/ ,& 1 p . Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUIILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION PA / n 1 5cJ 2 I WHIT/47 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 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 Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON ate C.C.F. Phone ?54-3 9 5 / 4 Signature of Contractor or Owner- Builder Notary as to Contractor or Owner - Builder Date My Commis$ ion Expires: - O,_ ' S NOTARY TOTAL DUE APPROVED: Zoning Building 0754 Electrical Mechanical Plumbing 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 nnist be kept at building during progress of the work. Owner's Name and Address_ n._.Ii 1a___I1ohC1 slr No Registered Architect and /or Engineer Name and address of licensed contractor tr l_t ainte.r.$ 213.1_ il 51s t. St, 7' Location and legal description of lot to be built on: Ph. 7 - 1855 Lot Block Subdivision State work to be done and purpose of building (by floors)____2.8int i Street and Number where work is to be done ,_and for no other purpose. New Building Remodeling Addition Repairs X______________ No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $_70Q..0Q Amount of Permit $ 1.00 - 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 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. 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. ,( 7('.7 Permit No._■.l 6 Date__ 1 _ ___ __ Read, Sworn to and Subscribed before me. Disapproved (Signed) Building Inspector Date Chairman Member Member Council Approved PLANNING BOARD DATE Member Member Member Date Disapproved Date ] T v'ovember ,19 47 7E Sg a. _31(.. St, NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice materials and /or workmanship. or changes to this application after approval /9 - /14 - t io to me well known, Notary Public, State of Florida My Commission Expires Date has been obtained from for inspection or faulty BUILDING ELECTRICAL PLUMBING Owner ofd Building ,, / 4 //,;;- A Lot MIAMI SHORES VILLAGE, FLORIDA DATE • - ':! ff '. PERMIT N? 5886 License Contractor's /g r^ rsw Permit t `-- iitwo- t t L Architect Contracto or Builde Legal Description Address of 7 value of 4 P. Building Project (/ � `� This pe it is grante to the contractor or b der nam d above to construct the buildin• or to install the equipment or evice described in the appli- cation herefor in strict compliance with all ordina = s 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 iliereby whether shown on the plans or drawings - r t1 a or in (atemealt'or specifications and tb t he assumes respon- sibility for work done by his agents, servants or employees. /L , 4.4. Signed G I • Y�7S` C � �� f . S f By;P . / Work to be performed under this Bl. Subdi- vision In consideration of the issuance to me of this permit I agree to perform the work c overed hereu er in compliance with 4pecl in antes and rpgpla ' ns pertaining thereto and in strict conformity with the ans, drawings, statements or specifications submitted to the proper authorr f Miami Shortjge. ork done by either myself, my agent, servant or employee. In accepting this permit I assume responsibility for 6ONTRrcTOR OR BUILDER VIA ( BY y -T S crk Amt. of Permit AUTHORITY 4 194 • ottinikilktk ga:a n . . <aii 0; . c !1+r +le;�'S�i 0... ';•: !:- �_'.. .•awq�'?•ir�.` c K_... a�9 e1c - BUILDING ❑ ELECTRICAL ❑ _ PLUMBING ❑ PERMIT ROOFING ❑ / 2,,7 , - - Work to be Owner of Building 4-i c=—l� -�__ Architect Contractor \ or Builder J�C -J�—�J /1 J_0i4 e / zC2 U Legal Lot C v' ,1 O' t l •4- 3 Subdi- M $ CP-t1 / 4 II vision S Q---4... % 4 �L) _ Description BI. I Sq Ft Cr. JC1 Address of ^ Building _!� fit. /"Gt. ST _c V Proj Project $ ,ceo. 11 Permit* $f /`.(i'l —' \• This permit is ` in �� p granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with am 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 plane 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 respon- sibility for work done by his agents, servants or employees. • Signed • � �� •' I ( R) BY In consideration of the issua to me of this per it I agree to perform the work covered hereunder in compliance with all ordinances and regulation* pertaining thereto and in strict conf rmity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit 1 assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR or BUILDER MIAMI SHORES - VILLAGE, FLORIDA _ /2-�-J N° performed 40214 SPECT G Date Contractor's License No. under this Permit BY AUTHORITY C� i )