1245 NE 92 St (4)BUILDING 0 MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL Date 19
PLUMBING o PERMIT N? 8145 Contractor's
ro
License No two
ROOFING ❑
O w of
B uilding g
TO "
CP. k. Cam. MO f of 4: ' #` -
Architect
Contractor 4 c.
or Builder
NA S Ta 1 ■';
Legal Lot I
Description I I B1
Address of
Building
Signed
CONTRACTOR or BUILDER
Work to be performed under this Permit
lot
N.44s. ' fr
Subdi-
vision
Sq Ft
Value of
Project
(INSPECTOR) BY
Amount
Permit
of
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 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 or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants emp1 'ees.
In consideration of the issuance to me of this permit I a to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, dra s, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work ne by either, myself, j agent, servant or employee.
BY
AUTHORITY
STATE OF FLORIDA,
COUNTY OF DADE. j 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 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. ��
• .. y�
Owner's Name and Address. Date Qw )) !!
Street.. .p__1 8 v 19.
Registered Architect and /or Engineer..._.. __. _ __
Name and address of licensed contractor _ -- ', �%LR -liy[ ,, 9'01
Location and legal description of lot to be built on:
Block. cg Subdivision.
or
Street and NU>'fib r where 8'
is to be done _ r
State work to be done and purpose of building (by floors)
//R C A,
/ ' 3_ -/--
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 $ a_D_Q Amount of Permit $ ..._b_i__Q_Q
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 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 La . .f Florida, Permanent Sup element,
and has complied with the provisions thereof, and will require similar compliance from all contracto . sub- contractors nployed by him
in the work to be performed under this permit; and will post or cause to be posted for in p ti.n no t si e of the work .uch public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub.y• " tor o• w•rk to be p: ormed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
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
, r :/ / + 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.
3y
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