128 NE 94 St (6)AP LL,O CATL N FOR t U B LL
Registered Architect an /or Engineer_._
Name and address of 1 4censed contractor..B0 0414
Location and legal de rription of lot to be built on:
Disapproved s D
(Signed) -
Building Inse ctor
� alit
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
BRIG PERMOT
4 2 1 implication is hereby n le for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
or other structure herei. described. This application is made in compliance and conformity with the Building Ordinance of Miami
ores 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 m- it be kept at building during progress of the work.
Date
oe /' , 19_+A3
Owner's Name and Address._ J /4C e Hodge- No Street
d 16e ai4-tok 11)Z-42S Ai et)
Lot Block c _
Street and Number here work is to be done 12 8 A e 94- a
St a ork to be dr,ne and purpose of building (by floors) 4 TDA) 4 Q doiu ._ S si? _ f 4. , -,
4 Doe) 67O 'L o-
®'- /tlE.) g..v QPeg@fc f (1) I t f ilia)
and for no other purpose.
Subdivision
New Building Remodeling Addition Repairs No. of Stories
To be constructid of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 1-'0 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 herby 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 th work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to ,.'e performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) �" 4
( 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 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 y true.
/ Permit No (((Q Date Read, Sworn to and Subscribed before me.
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 niade 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.
PERMIT APPLICATION FOR MUNICIPALITIES OF UAUh (mind
(OWNER TO RETAIN COPY)
Job Addrssk, . Bo2 $„ /U E 94 51- MInW i SHoRE • , Tax Folio 99 3206 - 013 -- WO
Legal Description
/ Leese• / tenant ' 7 ✓i4 MaiKavi
Owner's Address 1 2.5 !Y C ? ) SP
Contracting Co. `La) - c _ o n / c> Address 2 2 208 S W 6 0 t ik kfi G4 R
Qualifier G `5/40,L0,, -, M c ans+ 99D - -15_2 Phone 631 3 6-.2.
states tme Ceepetsnei" .. /p -7 Ins. Co.
architect /Engineer
Bonding Ceseepaey, 6�
square rt.
Mortgagor
Permit Type (eirel• one).
WORK DESCRIPTION
wARNtNO TO OWNER* !OU MUST RECORD D A NOTICE or COMENCEMENT AND YOUR Pnz r-.T 1 P
DO .90 NAT UMW IN TOUR PA!!XNC3 Twtcm FOR IMPROVEMENTS TO YOUR PROPERTY (TT:
INTP.HD . TO OBTAIN f NANOX $ CONSULT WITH YOUR LENDER CRt AN ATTORNEY BEBOP P
REcoR»2HtZ YOUR MOTION Off' ) •
Appiieatie>d LO hrrebW Sada te Obtain a permit te de work and installation as indicated Abore.
on the attached addeedtig (11 t iieable). I sortie, that all work will be performed to m.
standards of all mutating eeestruetied in thin jurisdietien. I understand that a *r
permits are required his lttI 'TMCAL, =mud, nod, POOLS, Rooms, and WECHANICAL
OWNER'S Atm man?' t aortal that 'all the teregeieg infdrmation is scour te and that all
will be denerie eempllasee With all applicable laws a traction and Tr
Furthermore, 2 autherile the &bemoeamed contractor to . � 'r t ee /.
JN _r9 6,
9ignatui of Owner and/or Condo President
e.
Dat 9 / q7
Notary as to Ove•r and)er Conde LL President
47 Co.emissien Ibtpirillf 41' / /q
* * * *
PERMIT FEas APPROVEDt Firs
► 5- . I c! n r
Si
Master Permit.
Address
Address
Address
Phone /756-- 9/ 64-
Estimated Cos
Date
or Owner - Builds
Notary as to contractor or Omer -B�J+
OARY PUBLIC, STATE OQA
My Cdsemissioti Expis1e1COMMISSION Extrnss/
BOND THRU NOWAY ►UBL)
Other
Building Electrical
Plumbing Engineering_