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1255 NE 93 St (11);UILDING LECTRICAL 'LUMBING IOOFING )caner of wilding address of , uilding f .rchitect -ontractor r Builder .egal Lot Description Bl. MIAMI SHORES VILLAGE, FLORIDA ❑ DATE 1 ❑ PERMIT N? 6 611 Contractor's License No. P In consideration of the issuance to me ertaining thereto and in strict conformity with pting this permit I assume responsibility for J d ,6ONTRACTOR OR BUILDER 7 G q • 195/ Work to be performed under this Permit ? �'��� = , Value of Project $ Signed ._ IN all work done by either,.- myself, my agent, servant or employee. f , / /- BY J Subdi- vision Amount 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 application erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any me 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 ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ertaining to the work covered hereby whether shown on the plans or drawings,,, cr in the statements or spycificati ns and that he assumes responsibility for work one by his agents, servants or employees. BY • of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- AUTHORITY 6 => MIAMI SHORES VILLAGE, FLA. JOB _aC i" - ADDRESS o a TX ' — � ? c' INSPECTION r o.) A - TIME READY - -s X° 7198 F s REMARKS. INSPECTOR DATE " MIAMI SHORES VILLAGE 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 -. ../ r- � Owner's Name and AddressY /' �d%I " / � � No Street 3 �✓ , 19 � Registered Architect and /or Engineer Name and address of licensed contractor. Location and legal description of lot to be built on: Lot p F' Block 1 Subdivision Street and Number where work is to be done APPLICATION FOR BUILDING PERMIT State wo to a done and purpo a of building (by floors) New Building and for no other purpose. Remodeling Addition Repairs No. of Stories To be constructed of Kind o foundatio Rogf. overing Estimated Total cost of improvements $..... 1 , 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 pennit 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) STATE OF FLORIDA, COUNTY OF DADE. j 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 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 e. / Date / Permit No.__.. Disapproved ( Signed) uilding Inspector BUILDING INSPECTION DEPARTMENT / Z- -' . - i4/ � 9 to me well known, Read, Sworn to and Subscribed before me. Notary Public, State of Florida 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 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 a' building during progress of the work. Date Owner's Name and Address Registered Architect and /or Engineer jn 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 1 q 3 y �_ Q State work to be done and purpose of building (by floors) 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 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 pennit 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, 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 subcontra ors, on work � o be performed under this permit, as are licensed by Miami Shores Village. Remarks ( Signed) 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 trug`.-- / ` - g �� Permit No /Q _(! ° Date L — ! 1 - . Read, Sworn to and Subscribed before me. Disapproved (Signed) Notary Public, State of Florida 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.