FENCEMIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Applicat on is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing o. other stru tore herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores VIllag-, F orida, and all previsions of the Laws of the State of Florida, all ord'nances of Miami Shores Village and all riles and
regulations of the Building Division of Miam Shores Village sh 11 be con plied with whether her in specified cr not. A cop of approv d
plans and specifications must be kept at bu,ldmg during progress of the work. -
Owners Name and Address ___ __ _t' t • G Ot..•._fl5_1v(
Registered Architect and /or Engineer _
Name and address of licensed contractor GI~N EIeAL- I-w_N_GE Co 1 H
Location a nd legal description of Fit to be built on:
, /
Lot_ __ ` 1 1, 5_ _ _ Block __ 4 5_ .. _ Subdivision__.M &±l! tmci _ S --r
Street and Number where work is to be done_ . 9
_.. ''
State work to be done and purpose of building (by floors) e hat r __I _l.!'f _k_ _ _TEr C �_ "C _ ,_ h_yt - _ --
- - - -- - -- - and for no other purpose.
New Building _ ___ ___ _. _ .Remodeling . __ _ -_ - _ Addition_ _ _ _- __ _ Repairs.__ ____._ _ .__ __ . No. of Stories -- _ .__._
To be constructed of _ _ Kind of foundation _ ____. _. __ ____ ___ _ __ ______ ___ Roof Covering
Ob Op
_ Amount 6
of Permit $ — • C I c -7_ (
__ � neo �- T - E et_
Estimated Total cost of improvements $ ___ I 80 _ __ __
Zone cubage required_ ._ __ _ - ___ _ _Plan Cubage
Distance to next nearest building_ __ _ __ _ __ __ __ _Size of Building Lot__
Maximum live load to be F:crne by each floor._
I hereby submit all the plans aid specifications for said building. All notices with reference to the building and its construction may,
be sent to _ C C N e4tA4.____ � ISk. C I - Nei • 7.� S 5--- _- nl_..W ._ _ - 2_410 _e VE._ _ ,
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an eniployer
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
m the work to be performed u -der this permit; and will post or cause to be posted for inspection on the site of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such : • tractors, on wo erforme�nder t •
permit, as are licensed by Miai. • Sho. es Village. . �y� j . C a •
Remarks (Signc `.) .0
STATE OF FLORIDA,
COUNTY OF DADE. j ss •
Before me, the undersigned authority, a notary publi.:, duly -.uthorized to administer oaths and take acknowledgments, personally ap-
peared - - --- -
Disapproved
(Signed) _
■
and who, being by ma fist duly sworn, upon oath deposes and says that he is the
of the above described const.u_tion, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated az true.
Per.; it No. __�_ J _ __ ? Date. __ . , _� Read, Sworn to and Subscribed before me.
D
BUILDING INSPECTION DEPARTMENT
Date_
Ms3tZ 29 -- 19 4o
__. No... ___3 X0 1•___ Street__ l ` " !� �
7.1_ N .W. _ ��• Ave
Notary Public, State of Florida
Building Inspe r My Commission Expires _ -
_ to me well known,
P ANNING BOARD_ _. - DATE
Chairman . _ _ _ Member .-
Member _. _ _ _ Member
Member . _ Member
CouT. ;il 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- in.pec:t'c_i 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.
ALLEY
f
S
•
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of k {
Building
Architect
Contractor /`
or Builder { -
Legal Lot
Description
MIAMI SHORES VILLAGE, FLORIDA �.
DATE 3 Z'6 19LCI
PERMIT
Address of
Building - ( 1" 4.
B1
N9 7352
t 7 F+ ��� '1 h ,
k- G
Value of '
Project $
Contractor's
License No.
3 G7
Work to be performed under this Permit—
Subdi-
vision
Amount of f ' '-
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. ,' il
Signed' :, t at• 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 authirities of Miami Shores Village. In as
cepting this permit I assume responsibility for an work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
ABBOT