15 NE 95 St (7)/f
rx /676 6. 7
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10, What can be done to prevent accidents like this one?
11. What have you done about it?
DATE
•
HEAD OF DEPARTMENT
(TURN THIS REPORT IN TO YOUR FINANCE DIRECTOR)
4
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
MIAMI SHORES VILLAGE, FLORIDA L
DATE /._! `' ' 19
PERMIT
0
Lot
In consideration of the issuance to me
pertaining thereto and in strict conformity with
ceptinq this permit I assume responsibility for
CONTRACTOR OR BUILDER
r .f
Bl
N° 4956
Subdi-
vision
Contractors ��
License No.
Work to be performed under this Permit
t !
l
Address of _ Value of Amount of `�
Building f 7 - Project $ I 1 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 applica-
tion 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 respon-
sibility for work done by his agents, servants or employees.
Signed. '..1 / s 4 4 .,.: f jai. - n' .E: � INSPECTOR
of this permit I agree to perform the work covered hereunder in complippmm'cce with all ordineuicea 'did regulations
the plans, drawings, statements or specifications submitted to the proper Iruthorities of Miami Shores Village. In as
all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
A1111OT