MECHANICALID
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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contracto
Location and legal description of lot o be built on:
Street and Number where work is to be done
State wo
Disapproved Date
(Signed) (zj
to be done and purpose of building (by floors)
Date
Lot Block / + �S
v
9i l ac —G,
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof vering
Estimated Total cost of improvements $ 4' C Amount of Permit $_. ..-,--
cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
s
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 subcontr ctors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed).
Notary Public, State of Florida
STATE OF FLORIDA,
COUNTY OF DADE. J
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. 2 Date 1 - Read, Sworn to and Subscribed before me.
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.
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
Owner of
Building C /
Architect
Contractor
or Builder
Legal
Description
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT 11T° 3699
Address Building
of r .i
Work to be performed under this Permit
•
Bl.
�4
Subdi-
vision
Value of
Project $
1
This permit is granted to the contractor or 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. t
./
BY
.fJ
DATR 195
Contractor's
License No.
,e
Amount of
Permit $ 7
BY
INSPE OR
In consideration of the issuance to me of this permit I agree to perform the wor covered hereunder in compliance with all ordinances and regul
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY