899 NE 92 Stpeared
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT'
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 bc kept at building during progress of the work.
(gig Mgt �A C�5 14A9eS .. No S ° _ Sf
Owner's Name and Address • ... �- �••••- -•• street NC cq
---
Registered Architect and /or Engineer �., .. ..�.�.. ^. TT TIZTIMTf
Name and address of licensed contractor G 1< 4 * 4 t- L C/9 6^/6- IS >.3 / /C - A/14/ '7./ d ,.'•
Location and legal description of lot to be built on: l
Lot C r:- b l∎ -' Block i Subdivision C :" �•,c ..... .�....._._.. ::� v
Street and Number where work is to be done g i. ^i E ' ° 1 S 1 •
State work to be done and purpose of building (by floors) - c�' ` l('— t / t -4-c- (to'�, - —`
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foo ndation Roof Covering
5
Estimated Total cost of improvements $ � ��' — Amount of Permit Sa. --
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 ins ?ection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such s work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Si
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and talte achnowledgments, personally ap-
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 ear,:e, and that Jl facts
therein by him stated are true. /
Permit No.._.__ Date Read, Sy., ;?t and Sub 'bed before r•�o.
,,fj Ze
Disapproved Date r .
Notary Public, St? b €v t1 l�fldfie STATE Or FQO IAA An LAM, (Signed) �1V etJfv9FliaooZ7R7 exGtt e9
,... -. S41?4. 20, 3973
My Commission Expires , U tEN.ER.m.i.3g4fl!RAWr " ERWRIT'
PLANNING BOARD .._ DATE
Chairman Member
Member Member
Member ...... _..._._..._._ .._._ -• -_ -_ Member -- - - - ---
Council Approved Date Disapproves' Date
NOTE: A charge of $1.00 will be made for making corrections or changes to eats application nftes approval has been obtained from
the Planning hoard.
A re inspection fee of $1.00 will be charged when such re- inspection in etude necesanrp by improper notice for inspzetinn or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE. FLORIDA
BUILDING ❑
ELECTRICAL ❑ PERMIT N. o
PLUMBING ❑ 9063
ROOFING ❑
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
DATE 195.
Contractor's
License No
Amt. of
Permit $
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 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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • BY
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
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
17
BUILDING
ELECTRICAL
PLUMBING
HO OFING
Dwner of
wilding
architect
ontractor
Jr Builder
-egal
)escription
address of
wilding
Lot
❑ .
❑ DATE 195 ! --
❑ PERMIT N° _ 4266 Contractor s
License No.
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
Bl.
Subdi-
vision
Value of
Project $
Amount of
Permit $
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 application
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me 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
ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
:attaining 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
one by his agents, servants or employees.
Signed. , ; BY
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-
,pting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY a'''
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Disapproved Date
(Signed)
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.
r Date
7 - �- , 195
Owner's Name and Address '‘7-1 � f �` __L— -- No Street
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 work to be done and purpose of building (by floors)
E
oz
- -!! -- and for no other purpose.
New Building Remodeling Addition Repairs l� No. of Stories
To be constructed of Kind of foundation Roof Covering J
�u
Estimated Total cost of improvements $ 1l 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 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) 11
r —_
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 Date Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
to me well known,
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.
Application is hereby made for the approval of the detailed statement of the plan 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 ordinarres of Miami Shores Village and all rules and regula-
tions of the Building Division of Miami Shores Village shall be complied with, wiether 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 C L
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
State work to be done and purpose of building (by floors)
1
Permit No. Date
Disapproved _--- --_ - Date
(Signed)
t duilding Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPART 1ENT
APPLICATION FOR BUILDING PERMIT
Size of Building Lot
Date_ �' �__ _ _ _ 19--
----------------- __and for no other purpose.
New Building__ _ _ Remodeling__________ —_ Addition Repairs No of Stortes____d' ___
To be constructed of'" _ — Kind of foundation_�.�_ __ __, Roof Covering____ ________
Estimated Total cost of improvements $ 7 _ ____Amornt of Permit $
Zone cubage required_ o n Platt Cubage _ _______ _____ —__— _
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
/ y. ,
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)
STATE OF FLORIDA,
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
and who, being by me firMY duly sworn, upon oath deposes and says that he is the_ _______
of the above described 6rnstr'ictio * that he bas carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr:a.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman _ _ - Member
Member ____ Member
Member Member
to me well known,
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 Punning 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.
Location and legal description of lot to be built on:
Lot____________ Block___
Street and Number where work is to be done
be sent to
STATE OF FLORIDA,
COUNTY OF DADE. j se.
Disapproved ___________ ___ Date
(Signed)
NOTE: A charge of $1.00
the Planning Board.
A re- inspection fee of $1.00
materials and/or workmanship.
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
i- _.J
Owner's Name and Address 7 r, �=
F
Registered Architect and /or Engineer •
Name and address of licensed contractor;
State work to be done and purpose of building (yq floors)
Zone cubage required Plan Cubage
Distance to next nearest building __ Size of Building Lot
Subdivision
; �,
Before me, the undersigned authority, a notary public, duly authorized
appeared
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
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 herein specified or not. A copy of approved plans
and specifications must be kept at building during progress of the work.
194-.
N o
__and for no other purpose.
New Building "' – `"- Remodeling " A
g Remodeli g �__ Addition -A Repairs No of Stories °#
To be constructed of.'', ' ,, __ . Kind of foundation - 2 2 t_ Roof Covering___ °- ______ e _____
Estimated Total cost of improvements $ � —_Amount of Permit $
Maximum live load to be borne by each floor
I hereby submit ,4,11_ the plans and specifications for said building. All notices with reference to the building and its construction may
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) _ c '
to administer oaths and take acknowledgments, personally
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.
J Permit No Date / � � Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires_
to me well known,
___Date
will be made for making corrections or changes to this application after approval has been obtained from
will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
JOB: AD:
BUILDING
ELECTRICAL ; • •
•
PLUMBING • • WORK
• DONE BY:
Inspector's Report:
REQUESTED
• • • •
•
•
•
•
•
•
• • •
•
The following is ready for Inspection:
•
•
: WILL BE READY
JOB:
BUILDING • •
ELECTRICAL
PLUMBING WORK
• • DONE BYO`
The following is r.:ady for Inspection:
Inspector's Roport:
•
•
AD:
; j�
•
• : REQUESTED
•
: WILL BE READY
JOB:
BUILDING
ELECTRICAL :
PLUI:BING
Inspector's Report:
The following is ready for Inspection:
•
• WORK 1
: DONE BY: /1
. RE inSTED
• • ` ▪ � 47s •
•
•
•
•
•
•
•
•
ILL BE READY
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N9 2775
Work to be performed under this Permit
Subdi-
vision
DATE
Contractor's
License No.
- Legal Lot Bl.
Description
Address of Value of f l`•_, C_� Amt. of /
Building Project t. Permit
This permiyys.gtanteel- te-thevemtra nstruct 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 or in the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed• By
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 regula-
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER liY AUTHORITY
194
BUILDING
ELECTRICAL
PLUMBING
Owner o
Building
Architect
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
PERMIT N9 2393
Work to be performed under this Permit
Contractor's
License No.
Contract
or Builde
Legal
Descripti
Address
Building
This permit is granted to the contractor or builder named above to construct the building 6r 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 or in the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed: By
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 regula-
'ns pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
illage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
n.
•
3n
Lot
(
•
Bl.
/
Subdi- -
vision .. r s t ,
Value of `t
Project �
1,,'[
,.
r S ,-
Amt. of
Permit
f
)f
BUILDING
ELECTRICAL
PLUMBING
Owner o
Building
Architect
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
PERMIT N9 2393
Work to be performed under this Permit
Contractor's
License No.
Contract
or Builde
Legal
Descripti
Address
Building
This permit is granted to the contractor or builder named above to construct the building 6r 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 or in the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed: By
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 regula-
'ns pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
illage. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
Street and Number where work is to be done
State work to be done and purpose of building (by floors) ,
Vits saF. n „:
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No ° 7 7 •C Date / 1/4 — 2l
Disapproved — ___________________________ Date
(Signed)
Chairman
Member
Member
Council Approved
Building Inspector
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 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 __ —_ _L______
Date — - -- -- -- --- -
No ._ G I _— '' Street' ` _ � I
A
' and for no other purpose.
New Building__________ - --___ Remodeling —__ Addition________ _ Repairs No. of Stories__
ti
To be constructed of_ r ___ :-- _ Kind of foundation____________________ Roof Covering_
___ ,
Estimated Total cost of improvements $Amount of Permit $____1
Zone cubage required _Plan Cubage
,
Distance to next nearest building f' "` Size of Building Lot —..� " ' " ^ , I a
Read, Sworn to and Subscribed before
me.
Notary Public, State of Florida
My Commission Expires____ __________.
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) _
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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 be has carefully read the foregoing application, and that he did sign the same, and
therein by him stated are true.
PLANNING BOARD DATE
Member
Member
Member
Date Disapproved
that all facts
Date
NOTE: A charge of $1.00 will be made for
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.
making corrections or changes to this application after approval has been obtained from
State work to be done as purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE.
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 herein specified or not. A copy of approved plans
and specifications must be kept at building during progress of the work.
p
19—
Owner's Name and Address No._' — Street `�i'� ? F
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot 1 Block___ —_ _i____ —_ Subdivision
Street and Number where work is to be done '' o) ''
Disapproved -- __ —_ —_ _ ___ Date
(Signed)
Size of Building Lot
�� _and for no other purpose.
New Building _ __. Remodeling Addition Repairs °' — No. of Stories___-- _______
To be constructed of_ � , Kind of foo ndation Roof Covering
Estimated Total cost o improvements $ �( %, _Amount of Permit $_ V...—
Zone cubage required —___Plan Cubage
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 ' nspection 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 o ractors, on work o b ' performed under this
permit, as are licensed by Miami Shores Village. . � /
Remarks (Signed) G �!
Building Inspector My Commission Expires
Notary Public, State of Florida
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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. 7 7 Date / 0 Read, Sworn to and Subscribed before me.
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.