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275 NE 92 St (11)Owmpr's Name and Address._. RegF,?ered Architect and /or Engineer._. _ Name and address of licensed contractor Locatio an4 legal descr•)BEipai f ' be b�ui� on: Lot Block Maximum live load to be borne by each floor___ I hereby submitall be sent to.__._ permit, as are licensed by Miami Shores Village. Remarks Permit No Disapproved (Signed) c Chaihnan _ Member Member Council Approved Date__ Building Inspector PLAN •d G BOARD Date 1 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. - -- �'°\ l am__ - ._ ___ ._ • _ ..__ No d. 3 ___ Street_ Subdivision Street and Number where work is to be done - VS - ei—_I State work to be done and pu o of building (by floors) _. N lIfkz4=4 __ -- -- - --___ =' ` ',. °-- - - - -- - - -- and for no other purpose. New Building Remodeling Addition __ Repairs No. of Stories 1„... To be constructed of Kind of foundation.._.. Roof Covering _...._. Estimated Total cost of improvements $ __l___D _1_ _- Amount of Permit $ 10. 00 Zone cubage required -Plan Cubage._ _. Distance to next nearest building__..__.. Size of Building Lot ans and ec ations for \ said building. All notices with reference to the building and its construction may 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 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 su .co tract.rs, o wor .S o be performed under this 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 sited are Jyue. - S Date.___.. Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires__ DATE Member Member Member . _._..._ .... Disapproved 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 b materials and /or workmanship. 20- Si , -1 La' Date f' / 7 • .. 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' ij 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 contractor_ Location and legal description of lot to be built on: Lot Block Subdivision___ Street and Number where work is to be done __ .z___. __ State work to be done and purpose of building (by floors)_ Disapproved (Signed) Date ��u and for no other purpose. New Building Remodeling Addition Repairs i!' No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $_ /JD 0 Amount of Permit $ 1• 0"0 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 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 _4,Y L _l : c 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 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 ?/ �v Read, Sworn to and Subscribed before me. Date 4 Notary Public, State of Florida Building Inspector My Commission Expires Chairman Member Member PLANNING OARD DATE Member Member Member a)c-9 ,1 Street 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 at building during progress of the work. 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: Lot Block Subdivision Street and Number where work is to be done STATE OF FLORIDA, COUNTY OF DADE. Permit No Disapproved (Signed ) } ss. A, (6 e (r. k a v1/4 Date No. - State work to be done and purpose of building (by floors) .1 _ it w._ R /?E MI 6 A MA/ R T 6/7 and for no other purpose. Repairs t No. of Stories New Building Remodeling. Addition To be constructed of Kind of foundigis Ro o C vering 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 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 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 ublic notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on w k to be perfo under this permit, as are licensed by Miami Shores Village. Remarks (Signed) _ � 1 � 1 ) , Street ,Crzei g 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. l' -- Date Read, Sworn to and Subscribed before me. m ate 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. Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision L1r,�C1 ui��;t�ta MIAMI SHORES VILLAGE New Building To be constructed of Kind of 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. Owner's Name and Address a '� ln-Si No ` 7 / Streeth (�? °' - web to 1,1 iyo Registered Architect and /or Engineer foundation Date Rerning. Addition Repairs «/* en , 19 Street and Number where work is to be done 2. e 9 1 State work to be done and purpose of building (by floors) y' ° t = = =„ P, and for no other purpose. No. of Stories 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 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 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 subcontracts, on wor to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. 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 true. / Permit No � r 7 / p Date 4-- Z Z b Read, Sworn to and Subscribed before me. Date Disapproved (Signed) f1 ) ss. to me well known, 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. Zone cubage required Distance to next nearest building_ STATE OF FLORIDA, COUNTY OF DADE. 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 regula- tions of the Building Division of Miami Shores Village shall be complied with, whether here. specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Building Inspector Owner's Name and Addres s Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be b ilt on: . Lot___ �_�_____ _ Block _____ Subdivision Street and Number where work is to be State work to be done and purpose of building (by floors) --- - - -- -- � / ----- --- --- - - - - -- -- -- --- ------ --- - - - - -- --- - - -- -- -_and for no other purpose. New Building v Remodeling__ Addition___— ______— Repairs _ No. of Stories To be constructed of__-- _— _________ Kind of foundation_ Estimated Total cost of improvements $_— ` dO _ _ — _Amount of Permit $ Date_ My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member - Member Council Approved_ — ____— _____� _— ___— __Date Disapproved _� _ — - 19 ,� Street— / P (2? Roof Covering __________ ____ ____-- __ — _____ --_Plan Cubage Size of Building Lot __________ _______________________ Maximum live load to be borne by each fl oor_— ___--__ — ________ — ____ _____________,__�_- -__�__ 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 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. rs Remarks (Signed)" 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him s ted are tru Permit No. ___ Date Read, Sworn to and Subscribed before me. Disapproved (Signed) Notary Public, State of Florida to me well known, —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. (over) 1. General Building Contractor.. LIST OF CONTRACTORS, SUB - CONTRACTORS, ETC. REQUIRING OCCUPATIONAL LICENSES MIAMI SHORES VILLAGE 2. Plumbing, Heating, Ventilating, Air Conditioning and Gas Fitting. 3. Electrical. 4. Architects, Engineer, Surveyors, Landscape Architects and Interior Decorators. 5. Excavating, grading, filling and Landscaping. 6. Moving or wrecking. 7. Septic Tank and Drain Field. 8. Brick, Stone, Tile, Cement Block, Concrete and Gypsum. 9. Carpentry, Millwork, Awning and Shutters. 10. Cement, Lime, Plastering, Stucco, Lathing and Cast Stone. 11. Decorating (interior and exterior), Painting, Waterproofing, Damp- Proofing and Paper- hanging. 12. Flooring, sanding or finishing; wood, rubber, composition, linoleum and other flooring not otherwise specified. 13. Ornamental Iron, Bronze and Steel, Steel Sash, Over -head Doors. 14. Roofing, Sheetmetal and Skylights. 15. Solar Water Systems. 16. Well drillers. 17. Sprinkler Systems of all kinds, including those for Buildings, Lawns, etc. 18. Structural and Reinforcing Iron and Steel. 19. Tile, Terrazzo, Marble, Granite and Cut Stone. 20. Electric Fixtures. 21. Illuminated Signs. 22. Bridge, Bulk- heading,, Drainage Sewer, Water and Gas excavation and Construction, Dredging, Irriga- tion System, Pile Driving, Sea Wall, Paving, Sidewalks, Curb and Gutter or similar work. 23. Every person, firm, co- partnership, Corporation, Association or other organization engaged in the bus- iness of supplying, furnishing or delivering building materials for any construction project within the Village Limits and not having a regularly established and licensed place of business in the Village. MIAMI S HOPES VI LLAG E 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 regula- tions of the Building Division of Miami Shores Village shall be complied with, whether here' 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_ To be constructed of__ Permit No.__ Disapproved (Signed) Building Inspector Name and address of licensed contractor_ c° -' Location and legal description of lot to be b ilt on: Subdivision C __ , Street and Number where work is to be done .d State work to be done and purpose of building (by floors) g Remodeling __ Addition Repairs New Buildin —____ Remodelin No. of Stories______________ Kind of foundation_ Roof Covering _ Estimated Total cost of improvements $ $ ml Zone cubage required_—____________ —_____ Distance to next nearest building 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 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), 4 ,Z4 f' 4-' STATE OF FLORIDA, 1 COUNTY OF DADE. j sa. 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 be is the _ of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him sited aretru Date Read, Sworn to and Subscribed before me. Date (over) -- ' D -- - - -. 19_ _ C, -i Street P ) • £ AO —Plan Cubage Size of Building Lot Notary Public, State of Florida My Commission Expires _and for no other purpose. to me well known, 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. LIST OF CONTRACTORS, SUB - CONTRACTORS, ETC. REQUIRING OCCUPATIONAL LICENSES MIAMI SHORES VILLAGE - 1. General Building Contractor. 2. Plumbing, Heating, Ventilating, Air Conditioning and Gas Fitting. 3. Electrical. 4. Architects, Engineer, Surveyors, Landscape Architects and Interior Decorators. 5. Excavating, grading, filling and Landscaping. 6. Moving or wrecking. 7. Septic Tank and Drain Field. 8. Brick, Stone, Tile, Cement Block, Concrete and Gypsum. 9. Carpentry, Millwork, Awning and Shutters. 10. Cement, Lime, Plastering, Stucco, Lathing and Cast Stone. 11. Decorating (interior and exterior) , Painting, Waterproofing, Damp- Proofing and Paper- hanging. 12. Flooring, sanding or finishing; wood, rubber, composition, linoleum and other flooring not otherwise specified. 13. Ornamental Iron, Bronze and Steel, Steel Sash, Over -head Doors. 14. Roofing, Sheetmetal and Skylights. 15 Solar Water Systems. 16. Well drillers. 17. Sprinkler Systems of all kinds, including those for Buildings, Lawns, etc. 18. Structural and Reinforcing Iron and Steel. 19. Tile, Terrazzo, Marble, Granite and Cut Stone. 20. Electric Fixtures. . 21. Illuminated Signs. 22. Bridge, Bulk- heading, Drainage. Sewer, Water and Gas excavation and Construction, Dredging, Irriga- tion System, Pile Driving, Sea Wall, Paving, Sidewalks, Curb and Gutter or similar work. 23. Every person, firm, co- partnership, Corporation, Association or other organization engaged in the bus- iness of supplying, furnishing or delivering building materials for any construction project within the Village Limits and not having a regularly established and licensed place of business in the Village. Ov:n r s Name and Address..Mx,.._. RegI eyed Architect and /or Engineer p_._� Name and address of licensed contractor �,a ._ Location and legal description of lot to be built on: Lot Block STATE OF FLORIDA, COUNTY OF DADE. Disapproved (Signed) u% ` 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. Street and Number where work is to be done State w rk to be done and purpose of building (by floors)._ New Building Remodeling To be constructed of Kind of foundation b Estimated Total cost of improvements $ �.Q� � — 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 foi 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 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) ss. MIAMI SHORES VILLAGE Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared UILDING INSPECTION DEPARTMENT 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 (74,7 Date____. i?5 —1 Building Inspector ` My Commission Expires Date____ p / t . , 19 No.. . )i7Vk Street e1c7 -.. / /0 ijId /ic Subdivision and for no other purpose. Addition Repairs No. of Stories Roof Covering p C o Read, Sworn to and Subscribed before me. Notary Public, State of Florida to me well known, PLA G BOARD __ . DATE Chatrnan _ . 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. 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 Villag3, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village 9nd all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified el not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address ` ' do ( -e [ 2 e 1 ` �� a _ No.___ . ?r. ___ _ Street___ !U : i = _ _ 7 z _ .J r Registered Architect and /or Engineer Name and address of licensed contractor_____________ 24Y .C16c £'- Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of ilding (by floors)__ C E er. c. / 54, s ����'+X r�QL �a y i 4aQ n �� _ 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 $ L. _ 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 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 u r 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 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 tru . Permit No.__ 7 _ Date l C-7 Read, Sworn to and Subscribed before me. Disapproved (Signed) (.� ( A Building Ins ctor MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT PPLICATION FOR BUILDING PERMIT Date- l Is G e a 6-- to me well known, 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.