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ROOFING PERMITSBUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building - Lot DATR o PERMIT N? _ 3884 CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA , Contractor's License No. ! � 1, L) 195_ Work to be performed under this Permit • B1 A: e BY j Subdi- vision Value of :. Project $ Amount of Permit $ This permit is granted to the contractor pr builder named above to construc the building or to install the equipment or device described in the application 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. 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 cr in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed• /4 Y INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered he under 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my ageyer; servant or employee. AUTHORITY 6 Owner's Name and Address Registered Architect and/or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: STATE OF FLORIDA COUNTY OF DADE. Permit No. Disapproved (Signed) } SS. 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 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 the work. Fah! k 142mA ork to be done and purpose building (b flo • OTAL • .371 9 o ' / 7 / Lot Uj o aJ Block Subdivision D Street and Number where work is to be done A A /IMMI % J r� d C I Sta ■rs) state exter'.r colors (submit samples) l• _ 9 f f1 ffig A , D// w/ /, / ?//7/ no of er . r os . N '� � �, , New Building Remodeling Addition Q �r ♦ No of Stories 'lb be constructed of Kind of foundation Op � C , overing Estimated Total cost of improvements S ___��v Amount of Permit 30. Op Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor 1 hereby submit all 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 obligatons 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. n A Remarks (Signed) e/ Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared 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. XT / c 1 Date_ _ Building Inspector Date Read, Sworn to and Subscribed before me. Vvw Notary Public, State of Florida to me well known. My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.