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MECHANICAL PERMITSRemarks_--_ - •- -- -- -- _ — SfL ES V LLAUE BUoLDD G ONSP OTuON DEPARTMENT 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 I:e;ein described. This application is made in compliance and conformity with the 13uildin Ordinance of Miami Shores Village, FIT iaa, 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. Date r Date--- (F._. r / .. t e K ,190 Owner's Name and Address ! l _ . 4E 4/GL O S / // Street /V (! Registered Arch test and /or Engineer Name and address of licensed contractor_-_ ,,,, Location and Iegal description of lot to be built on: Lo ._. . _._. . Block - Subdivision Street and Number where work is to be done__ _ / State work to be done and purpose of building (by floors)_ be sent to— _ `. 7 ' 1 1 / / '7V Council Approved . _ _. __ _ __Date Disapproved P. / /VC 3 8 -0U �! ` 4' - C .._ / -o' A - c . and for no other purpose. New Building Remodeling ______. _... Addition Repairs No. of Stones To be constructed of Kind of foundation Roof Covering � �o 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 tih e 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 Ce eral Laws of Florida, Permanent Sup lenient and has complied with the provisions thereof, and will require similar compliance from all o actors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for insp c ' n on the site 4f`th / work such ublic or notices rs are required by the Act. The undersigned agrees to employ only such subcon tors, ,on wo Z //// -.y permit, as are licensed by Miami Shores Village. r peP 0 0nrle ry (i31lya Z -this STATE OF FLORIDA, COUNTY OF DADE. ss 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. 1. 3 Date. 7- 3_ --6.7 Read, Sworn to and Subscribed before me. Disapproved (Sigced ) Notary Public, State of Florida u 'ding Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member -- Member Member Member 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Permit No Owner's Name and Address Registered Architect and /or Engineer Employing Electrician's Name STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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 work. No Street No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No !/ Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories • Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L .Metal Moulding '� Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands r.nd 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 worts to be performed under this permit, as are licensed by Miami Shores Village. (Signed) - 1 Date 7 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES N O. LAMPS REFRIG. OUTLET IRON O UTLET RANGE OUTLET RANGE CONN. WATER H EATER W. HEAT. CONN. SPACE H EATER STRIP H EATER TOTAL. CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. M OTORS 0.1 HP MOTORS 1•5 HP N EON TRANS. RADIO TOTAL CONTR. LIST ••N / / - ' CHECK • Permit No Owner's Name and Address Registered Architect and /or Engineer Employing Electrician's Name STATE OF FLORIDA, 1 COUNTY OF DADE. ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 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 work. No Street No Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No !/ Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories • Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L .Metal Moulding '� Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands r.nd 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 worts to be performed under this permit, as are licensed by Miami Shores Village. (Signed) - 1 Date 7 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING El Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building MIAMI SHORES VILLAGE, PERMIT N? 8802 CONTRACTOR OR BUILDER BI. FLORIDA DAT' 195 Contractor's License No. Work to be performed under this Permit__ Subdi- vision Sq. Ft Value of Project $ Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applicati )n herefor in strict compliance with all ordinances 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. Th:'s 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 thorcugh 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 responsibility for work done by his agents, servants or employees. Signed: BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY `" 17 e.,27 Estimated Total cost of improvements $_1191_.L Disapproved __.j2 __ Date (Signed) Chairman Member Member Council Approved MIAMI S Date RES 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. Owner's Name and Address___Ortk___U 2_11_ Da E NI, Registered Architect and /or Engineer Name and address of licensed contractor 1u C.&_"_1: 41-.t. I ' C.o 6 Ce) it D E 1 A U&-: , Azit 4 Q Location and legal description of lot to be built on: Lot_ _ _ Block Subdivision Street and Number where work is to be done 2/ g Aiir G11 i ?. _ State work to be done and purpose of building (by floors)._ ALE_ Cry LA- E)J__;7 _Dz!_z_ r _� a k' 5) p -' ^v,�( and for no other purpose. Ne'dding ('T` Remodeling Addition Repairs No. of Stories 4C l�` To be constructed of Kind of foundation Roof Covering Amount of Permit $ e f Zone cubage required_ ___.Plan Cubage z \ Distance to next nearest building __Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the p s and specifications for said building. All notices with jeference to the building and its construction may be sent to__ a Y2 A' d _ / 4 t /Kr . tP SSC e {l.' " 4-f ' 1 LE - L M ( 6 t?el 1 if t tf Date 3 —B No. LW: Street q g'; 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) Notary Public, State of Florida 19 ( se , STATE OF FLORIDA, `l Q G'k_ U � k9s _L &a COUNTY OF DADE. f ss • 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 _____ _U — Date ad, Sworn to and Subscribed before me. Building Inspector My ommission Expires PLANN BOARD DATE Member Member Member 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 r itice for inspection or faulty materials and /or workmanship. • C MIAMI SHORES VILLAQ3E � 7/02, ELECTRICAL INSPECTION DEPARTMENT A PLIC TIDN FOR ELECTRICAL PERM Permit No Y Date 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 work. Owner's Name and Address )1'7'11- ' � -a. �` ��. � � o , / 7 .t'' Street 'I" , ''` _ - 2" „,.;: ' i Registered Architect and /or Engigier._.. f� u Employing Electrician's Name = ^� Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ .., C Electrical Inspector. 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 subcontractors 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. STATE OF FLORIDA, 4 COUNTY OF DADE. Yl SS. `. No.. . ▪ s tfeet (Signed) f;-„ Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS MOTORS N EON 0-1 HP 1.5 HP TRANS. RADIO TOTAL CONTR. LIST "/1,.//, j , _ :tA x.. - G - 3. - r � .1 - -, j t CHECK • C MIAMI SHORES VILLAQ3E � 7/02, ELECTRICAL INSPECTION DEPARTMENT A PLIC TIDN FOR ELECTRICAL PERM Permit No Y Date 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 work. Owner's Name and Address )1'7'11- ' � -a. �` ��. � � o , / 7 .t'' Street 'I" , ''` _ - 2" „,.;: ' i Registered Architect and /or Engigier._.. f� u Employing Electrician's Name = ^� Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ .., C Electrical Inspector. 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 subcontractors 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. STATE OF FLORIDA, 4 COUNTY OF DADE. Yl SS. `. No.. . ▪ s tfeet (Signed) f;-„ Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other stru ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Villag -, Fonda, ' and all provisions of the Law of the State of Florda 311 ord;nances of Miami Shores Village ^nd all rules and regulations of the Building Division of Miam Shores Village sh...11 be co with whether h-r_in specifie% . not. A cop of am. row d plans and specifications must be kept at buid.ng during progress of the work. � `" Dat_ Owner s Name and Address /� - -- No. Registered Architect and /o_ Engineer_ Name and address of licensed contractor __ ___ Location and legal description of lot to be built on: Lot Street and Number where State wor be one an Block work is to be done Distance to next nearest building_ Remarks__ _______ _ _ STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, peared Permit No.__ Disapproved c)re_ MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT Date__ D BUILDING INSPECTION DEPARTMENT -- Subdivision__ Purpos of buil i (by floors) m Maximum live load to be borne by each floor ( Signed) __ and for no other purpose. New Building Remodeling Addition Repairs _ No. of Stories To be constructed of Kind of foundation ©Covering Estimated Total cost of improvements $ _. __ 7 �' ✓ _Amount of Permit $._ Zone cubage required____ plan Cubage Size of Building Lot _ 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 subc tractors, on wo t -be- :,performed under this permit, as are licensed by Miami Shores Village. /� a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- _ 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. Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspe.'or My Commission Expires _ ANNING BOARD __ . _ . __ DATE Chairman .. __ _ __ _ _ Member __ Member Member Member _ _ _ __ ___ _ __ _ Member Council Approved ___ Street__ _ ___ _ ..)&4 o/ji/ .G'2- --- - - - - - - -- -- -- Date Disapproved __ Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after apps ..1 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. MIAMI SHORES VILLAGE, FLA. N® . JOB 1 1'7 ADDRESS INSPECTION a `� TIME READY 7" 'A J REMARKS : INSPECTOR DATE 6242 i MIAMI S C RES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR U LDING 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. Date__ pV_d g , 19....... Owners Name and Address . z w^ i_ -_ - _ .. _� _- - 7 No __ t! .i ._ reet 7.. Registered Architect and /or Engineer._.. Name and address of licensed contractozll� ,e.,7-- _z�. _ Location and legal description of lot to be built on: Lot Block Subdivision pp , Street and Number where work is to be done._- .a__�l-_7-__./ 9 " State work to be donefind Brpose-.of building (by floors)_ • L and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering j Estimated Total cost of improvements $..sS��? r 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 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) rte_ �'�`_L -� • STATE OF FLORIDA, COUNTY OF DADE. ss. 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 Date J Read, Sworn to and Subscribed before me. Disapproved �„ f' Date ,. (Signed) /.� ! , �� Notary Public, State of Florida Building Inspector / ~ My Comm' 'n Expires PLANiG BOARD DATE Chairman G 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. Permit No G' Disapproved (Signed) Chairman Member Member .. 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. '' n� pp ��.!! o � _ H ,19 Owner's Name and Address . _.Ce. .�'4 QQ .w. �'gli l ?__& . .( _� No. H Street...( 'd.E 5 Registered Architect and /or Engineer ..... .. ....... 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 flgors) i Date Bui ding Inspector 0c> and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of found ton Ijoof Covering Estimated Total cost of improvements $ 2 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 pernit 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 Su dement, and has complied with the provisions thereof, and will require similar compliance from a 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 ' - ection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ rl such sui .ntractor on wor J lto be perfo . ed under this Remarks AWL - '/ permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. ss. 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. Date �� Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLA INC BOARD DATE � 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 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.