1130 NE 91 Terr (2)Name and address of licensed contractor
Street and Number where work is to be done
Disapproved .__.
(Signed)
NOTE: A charge of $1.00 will be made
the 1'I.rnnir,;. lioard.
A rc•mspe(tion fee of $1
materials and /or workmanship.
MSAMB SHORES V LLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ur toe plans and specifications herewith submitted for the build
inc 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.
State work too be done and purpose of building (by floors) i
L. PO C.% G' v)
Building Inspector
Date
PLANNING BOARD
Chairman
Nlcrr,ber
Member
-
Council Approved Date
,S
ate
Owner's Name and Address M °1 Mrs C,
Registered Architect and /or Engineer . P1 t M , aG� 0 , ,... ,.....- •,,.,,,., -.,
d U 4 G crao4nc, tiR h1 MAC
Location and legal description of lot to be built on:
Lot / Block r Subdivision
ez6Q
and for no other purpow.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of ec0 Kind of foundatiio 3 1:el- . Roof Covering 6' czA- w.L'(�
.... _
Estimate !l Total cost of improvements $ ®®®° Amount of Permit $..
Zone cubage required s .Plan Cubage
Distance to next nearest building ?' Size of Building Lot i S � /
Maximum live load to be borne by each floor ,/O /E
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 umlersigncd 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 Sup )lenient,
and has complied ssitlr 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 noticcs as arc required by the Act. The undersigned agrees to employ only such su ntractors, on work to kI2 performed under this
permit, as are licensed by Miami Shores Village.
Rem.uks (Signed) - a _ / .___
STATE OF FLOIIIDA,
COUNTY OF DADE. 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 ti.e above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all foes
therein by him stated are true.
Permit No... �` Date ‘) )v q19 Read, Sworn to and Subscribed before me.
§ts„ G ✓e r
cP,
to me well knot ra,
Notary Public, State of Florida
My Commission Expires
................_.._......DAT
Member
Member
Member — .._.._..
Disapprov Da:e
for making corrections or changes to this application after ngtprova! has hem obtained drraa:a
.00 will be charged when such re- inspection is anode necessary by Improper notice fox ins Linn a fr�tnitq
w>
4 ..
4
.:■./.
•
i
BUSINESS 11849 GRIFFIN BLVD
ADDRESS 06
DADE COUNTY
TRADE
NAME
CORP.
NAME
MAILING
ADDRESS
CITY
STATE
ZIP
THIS LICENSE ISSUED IN PURSUANCE OF METROPOLITAN DADE COUNTY ORDINANCE — 66-2
1S HEREBY LICENSED AND AUTHORIZED TO DO BUSINESS
AS A CONTRACTOR AS SPECIFIED HEREON.
THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED BY RECEIPTING MACHINE SHOWING NUMBER - DATE - AMOUNT PAID
DUE
OCT 1ST
CROWN BUILDERS INC
11849 GRIFFIN BLVD
N MIAMI FL 33161
10 06722
EXPIRES SEPT. 30 1980
COTIIRCTOTS OCEPulTiG I,
1919
STATE NO
CERT. OF COMPETENCY
TYPE OF CONTRACTOR
BAL HARBOUR
BAY HARBOR ISLANDS
GENERAL BISCAYNE PARK
CORAL GABLES
EL PORTAL
FLORIDA CITY
GOLDEN BEACH
HIALEAH GARDENS
AMOUNT 300.00 ISIAAMNDIA
MIAMI BEACH
MIAMI SHORES
ADD'L CATEGORIES NORTIH SPRINGS BAY VILLAGE
NORTH MIAMI
NORTH MIAMI BEACH
300.00 OPA LOCKA
TOTAL AMOUNT PENNSUCO
SOUTH MIAMI
SURFSIDE
SWEETWATER
VIRGINIA GARDENS
6 N 0 7 9 3 0 0.0 0 WEST MIAMI
PAYMENT RECEIVED AS CERTIFIED ABOVE — DADE COUNTY TAX COLLECTOR. MIAMI. FLORIDA
L
cEKsE 0 97105 1
ACCT. NO.
THIS LICENSE VALID ONLY IN
MUNICIPALITIES LISTED BELOW:
LICENSEE MUST REGISTER
IN CITY WHERE WORN IS DONE