810 NE 91 Terr (2)MIAMI S H O R E S 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 he complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progrc . of the work.
STATE OF FLORIDA,
COUNTY OF DADE.
SS.
Date
No.
,19�
r.1 '
Street_ l_
Owner's Name and Address
Registered Architect and /or Engineer.___
•r
Name and address of licensed contractor__ - +_:_:____'t.
Location and legal description of lot to be built on:
Lot Block Subdivisian_.________
1
Street and Number where work is to be done _ fi ''^ ._ .�r- y
State work to be done and purpose of building (by floors)
y' t,
and for no other purpose.
New Building Remodeling. Addition Repairs. No. of Stories
To be constructed of Kind of foundation____ ___ Roof Covering -
Estimated Total cost of improvements $ Amount of Permit $.___
Zone cubage required .flan Cubage
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 o: 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)...) ____: 1 '
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 Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
( Signed)
Building Inspector My Commission Expires
PLANNING BOARD 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.
MIAMI SHORES VILLAGE, FLORIDA
DA
ECTIUCAL ❑ PERMIT N° 14252
>
cam.
PLUMBING ❑
ROOFING O Work to be performed under this Pozmit
Owner of
Building N.& % ....„1_,.., .*,...
Architect
Contractor ;
or Builder
sa
Legal Lot
Description
Address of
Building
This permit is to the contractor or builder named above to construct the budding or to in/Sall the a}nipmeot or &via.
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be . paformsed in
drawings, statements or specifications that may have been submittal to and approved by the proper municipal ap Zak Permit
if the work is not done in com with such ordinances or if the plans ace changed without audiocisation. v _
granted is the undemanding that the r or builder named above assumes the for a
pertaining to the work covered hereby whether shown on the plane or drawings or in the statements or
done by his agents, servants or em
Signed:
In consideration of the issuance me of this permit I sine to stailipsinns
pertaining thereto and in strict confon with the plans, draw,
In accepting this permit I assume responsibility for all work done by Oast, m
CONTRACTOR OR BUILDER
`r",. t..
t ths pamper
lit Sink Wind* Or employee,
BY