660 NE 95 St (4)•••■••••••
'Village of Miami Shores
•
N? 3870
JOB D12. 44.4_„ T
ADDRESS l !?i • c g
INSPECTION r E' oc) •� _ v ri ) n-y •
TIME READY
REMARKS
1 4,
INSPECTOR DATE 3- 6 -- �"�
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 nnist be kepi at building during progress of the work.
STATE OF FLORIDA, I
COUNTY OF DADE.
Chairman
Member ____
Member __
Council Approved. .__
ss.
MIAMI SHORES VILLAGE
Owner's Name and Address/2Y:
Registered Architect and /or Engineer
✓Name and address of licensed contractor.
Location and legal description of lot to be built on:
Lot f e -- Block.-- -_ ® /
✓Street and Number where work is to be done____!a2__Q
i /S { tate work to be done and purpose of building (by floors)._
bell
BUILDING INSPECTION DEPARTMENT
ob __ >
t_/ -- -Q'!/.4
Subdivi
Date
!11_:
Remarks__ ___.. /Signed)
No
PLANNING BOARD DATE
Date_ _ / — , 19•f
Street
—
and for no other purpose.
New Building___________ _ .. Remodeling__- Addition
To be constructed of Kind of foundati _ .._ Roof Covering ... ... ....... __.
/stimated T:,tal cost of improvements $_.. /h_ Amount c` Permit $
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 the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
Repairs_.._._ .._ __ No. of Stories
The undersigned applicant for this building permit does hereby certify hat 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 rovisions 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 sibcorttractors, • on work to be performed under this
permit, as are licensed by Miami Shores Village. t°4n
>
Notary Public, State of Florida
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 th ' abov: 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
(Signed) '
B ilding Ins.ector My Com:nission Expires.
Member
Member
Member
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.
UILDING
LECTRICAL
LUMBING
OOFING
wner of
hiding
- Chitect
:ntractor
Builder
gal Lot
=scription _ Bl
dress of ;•
gilding
CONTRACTOR OR BUILDER
Value of
Project $
Amount of
Permit $
MIAMI SHORES VILLAGE, FLORIDA
ID
❑ DATF z ` 195
PERMIT NNT9 3307 Contractor's
❑ License No. i -
Work to be performed under this Permit
Q -.
Subdi-
vision
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
refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
=wings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
=e 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
=nted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
ale by his agents, servants or employees.
Signed-
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
ting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY e