1015 NE 92 St (8)Registered Architect and /or Engineer..
Chairman _
Member
Member .
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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 '7 tA, L, V 9 ,19_e.. r L'.
Own9-'s Name and Address___ 3 r_ i (y: L eG I .__ -- ----- --- • -- -_.. No a' ' C. - _ -- Street.4'g #
Name and address of licensed contractor_ t i v+A-S PG$4/' % N 6 CO
Location and legal description of lot to be built on:
Lot__ Block .. _.. _ Subdivision_
2 r i�fcfl
Street and Number where work is to be done L -? N o y
State work to be done and purpose of building (by floors). ke. a P= cA
®
or ,VcSP;14-Z-1-1-1---
and for no other purpose.
New Building V Remodeling _ __ Addition __ Repairs No. of Stories
To be constructed of Kind of foundation___. Roof Covering__
, c
Estimated Total cost of improvements $ s e c 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 form said building. All notices with reference to the building and its construction may
be sent to.... –
The undersigned applicant for this building permit doe hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act. being Sec :ion 5966, Compiled General Laws of Florida, Pennanent 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) L �°� `� . s��.�- -°
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,
therein by him stated are true.
Permit No.__(_n 4: Date ___
Disapproved _.__ _ . ____ __ D' e
(Signed) & J ' Z —
Building Insp
ANNING BOARD
Read, Sworn to
o .
� nQ
Notary Public, State of Florida
My Commission Expires_
G,
and Subscribed before me.
DATE
Member
Member
Member
_Date Disapproved .__..._
and that he did sign the same, and that all facts
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.
I
i
If
BUILDING ❑ MIAMI SHORES VILLAGE FLORIDA
ELECTRICAL LI Date 7 '
PLUMBING ❑ PERMIT 1■19 10243
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder Vv. % t 1
Legal Lot
Description I 1 1 B1
Address of
Building I e
CONTRACTOR or BUILDER
t3
Work to be performed under this Permit
I!
11
Contractor's G 1 ,
License No.
Subdi-
vision
Sq Ft
Value of 11 Amount of
Project $ 11 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 applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with an
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 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.
Signet (INSPECTOR) BY
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation,
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 agept, servant or employee.
BY AUTHORITY
194