65 NE 92 St (7)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 bc kept at budding during progress of the work.
Date • 19
Owner's Name and Address _,_ .
— No Street.---
Registered Architect and/or Engineer 11 ./1,1211,_ I'
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 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 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pennit, 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 'mown,
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.
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING 130ARD 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 hecn 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 ow faulty
materials and /or workmanship.
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* - - REQUIREMENTS UNDER CHApTER,10. DADE COUNTY, AS
-4J�E. ��' ` 1HEREBY - \�E��|�|Fn , � . AN �L[GK�.� E'' ••�-^-|m THE pOLLOVV|NGTRADE CATEG(�RY
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- .P4V1h� �N t..; 1 N E E R I N C ;
- THE ABOVE NAMED PERSON IS BEING CERTIFIED AS MAINTENAN
'ONLY WHEN HOLDER IS EMPLOYED BY THE FOLLOWING EMPLOYER:
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THIS CERTIFICATE IS NOT AUTHORIZED FOR USE UNLESS PROPERLY VALtDATED.
ALTERATION, REPRODUCTION OR TRANSFER OF THIS CERTIFICATE IS PROHIBITED.
THIS CERTIFICATE |S GOOD UNTIL SEPTEMBER 3OTHl9 TRADESMAN'S COP
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FEE FDn THIS CERTIFICATE
�M '' ���FF&�m[� ~/ WAS�PREV0USLYPA0ONRE
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��v�+�wu/�c�xuu�/ NUMBER
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' THIS ERT<F|CATE |3 VALID
NOT VALID WITHOUT SIGNATUR
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ON A COUNTYWIDE BASIS IN THE
| THIS CERTIFICATE IS V
UNINCORPORATED AR A AND IN ALL MUNICIPALITIES OF
DADE COUNTY. THIS CERTIFICATE AND ALL THE PRIVILEGES
AND RIGHTS THEREUNDER ARE NOT TRANSFERABLE AND
THE INDIVIDUAL CERTIFIED HEREON IS RESPONSIBLE FOR
FULL COMPLIANCE WITH ALL APPLICABLE REGULATIONS AND
CHAPTER ~`""""~ `
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PERMANENT CONTRACTOR'S
NUMBER
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CONTRACTOR'S
CERTIFICATE OF COMPETENCY - BUSINESS
METROPOLITAN DADE COUNTY
TFTHIS IS TO CERTIFY THAT —77-7
ASSOC 1A1 rie"..it,
i 1Y IL AKA PA KLAU Li;1 sk:RV
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1iI ILLAK:i ^aS
FEE FOR THIS CERTIFICATE
WAS PREVIOUSLY PAID ON
RENEWAL NbTICE AUDIT NO.
03770? -..
AS. L;CI.YES_ ►it 131 =�E L
;;kA a gFtKINi. Lill ` I:-.RY
HAVING MET THE REQUIREMENTS UNDER CHAPTER 10, CODE OF METROPOLrTAN DADE COUNTY, AS
AMENDED, IS HEREBY CERTIFIED AS A CONTRACTOR IN THE FOLLOWING TRADE CATEGORY OR
CATEGORIES:
WITH ALL WORK TO BE DONE UNDER THE DIRECT SUPERVISION AND CONTROL OF THE FOLLOWING
NAMED QUALIFYING AGENT:
S t k i : 2 66 '..)C I.'.);i 1
This certificate is valid on a countywide basis in the Unincorporated
Areas and in all Dade County Municipalities. The qualifying agent and
organization listed herein have been duly qualified by the Construction
Trades Qualifying Board. This certificate becomes null and void at such
time. as the qualifying agent named herein is nb longer associated with
the above named organization.
THIS CERTIFICATE IS GOOD UNTIL SEPTEMBER 30, 19 rc4
(Secretary Construction Trades Qualifying Board)
THIS CER FICATE IS NOT AUTHORIZED FOR USE UNLESS PROPERLY VALIDATED.
ALTERATIbN, REPRODUCTION OR TRANSFER OF THIS CERTIFICATE IS PROHIBITED.
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CONTRACTOR'S COPY