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BUILDINGMIAMI 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. Date G, " a , 18:7. ✓_ Owners Name and Address.A i 4 0 if c r e S _ r i r C4.. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done GcP — New Building Remodeling To be constructed of_GJ c': a y�r -. � PLANNING BOARD__ __ . DATE Chairman Member Member -. Member Member ... ._ .. Member Council Approved _Date Disapproved N M.S Street__ - 4 ci Registered Architect and /or Engineer Name and address of licensed contractorh./4 (12-1 moo_ N.1i. • C o • - - / N ,fi � ST State work to be done and purpose of building (by floors)__._._ c c P • 77 ems/ tai oo d . L e c - *, PTO b Pe .re{J 0 5 i e„ '- i kI d o f?_: 2.e_.811 1 1 to'.1< / • /9 er.4 TIP` and for no other purpose. Addition Repairs No. of Stories (- -- Kind of foundation Roof Covering f Lc� t Estimated Total cost of improvements $ � a 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, Pennanent 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 s ]ntr tors, o work t be rmed under this permit, as are licensed by Miami Shores Village. Remarks_ - - - - (Signed) STATE OF FLORIDA, COUNTY OF DADE. f 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 state are true. Permit No._ Date Read, Sworn to and Subscribed before me. Date_ — Disapproved PP - _-_ Notary Public, State of Florida Disa ( Signed) Building Inspector My Commission Expires. 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. 754 -5237 Owner's Name and Address MIAMI SHORES BAPTIST CHURCH . Registered Architect and/or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: New Building Remodeling STATE OF FLORIDA COUNTY OF DADE. } ss. Permit No. 5 Z5 Date / Disapproved � �`\ (� Date MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Addition Repairs No of Stories To be constructed of Kind of foundation Roof Covering Estimated lbtal cost of improvements $ 3407.00 Amount of Permit Sz"T • v 2.6 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor 1 hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to 3. / 9 S - yi -g990 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 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. Date OCTOBER 19 , 1989 �� 3 reef _TrLL]3T MIAMI SHORES, FLA. SiCUH1 WINUUWb. SEYMOUR GOTHELF. 5100 N.W. 72 AVE. MIAMI, FLORIDA 33166 Lot i& Y / 7 Block c3 Subdivision m 5 /Lei of /it 06 / O Street and Number where work is to be done 425 N .E . 95 STREET , MIAMI SHORES FLORIDA . State work to be done and purpose of building (by floors), state exterior colors (submit samples) REPLACING 25 STEEL CASEMENTS_ WITH and for no other purpose. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer % Labor under the Florida 11'orknwn s Compensation Act, being Section 5966. Compiled General Laws of Florida. Permanent Supplement, and has complied with the pr . ions thereof. and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under is permit; and wi 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 agr• . employ onl , : F. 'ork to be performed under this permit, as are licensed by Miami Shores Village. —_ Remarks (Signed) �` =� —�� 03 6. 9 4 4 Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared }T t Q,G 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. to me well known. Read. St4orrt, to and Subscribed before me. - t— Notary Public tfOfARY PUBLIC STATE OF FLCRIDA NY COMMISSION EXP JULY 25,1991 BUNDLE) TJRU GENERAL INS. UND. Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 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 $25:00 will be charged when such re- inspection is made necessary' by improper notice for inspection or faulty materials and/or workmanship. • v .:i4,1! r 412 ".*7-aii,egmm teictrelstos forth' Widen lageed.W ' • 'fie ifs' 1* . a 10:1, r� Arostswit,ss inurog OA. itrassmigol b t NO large 4 • '::iosee diStOrogit betesee &WWI en iestiriectiope free lho. t Ware , ''' . toast .. eed Stata ordincesem and risestl vnbbxo health led seilegr. .4441 10 Oeureedlog, ter geserig botftdiad wor+dla• `3ps* ' opatarattox for e ,far tiro end tereedoi'Iaceresee . *r ittikin p d ti 4 - fi tee dip or' -, �00M 1i its amts dS , bolleelser tinsel , / - tot Cot, v .'I. I � . branched . dD 'elkelt be the best e' thins . tise, ta Ildice rte sea0 1 tip 1 ✓ totele aid. vedgeacchicidoe4 'o ipeastesiG 401 odoemptagare slue la r *i auk raieitse i IA v lemigellabiou • 10040 .t •I'• 'r►'• i'. • .• . t A •, • 4: • • 1, • • . . i ". I. w�► . @t�F: ;�i:. vr l 4 ,' .11 sun torgoirafxr sad asset .set'O► 1,7 Thera a.. .4 - at1 est% orsl Aitsio nt Milers tor ; tip' � Ustoiss of SS rt# ►. 1 „gliortitiodi tog Tose ' 1 a' ' ' *sto iota Oslo s 0, �:: 1►' ; *VW SIVitsatsrs p1404 0 z .1M blesks. for atiadaSt •s1 ss 1 1� - . f rq" , s s ¢!• ' •3 d pn gwlr�. r i' 2':r' r 4K ;. ..I .ta ia1 ► rid L i M. and n • * •• a i r ! t t 'b. A R .s 4 `+i'►' omtn• nod ::4 ti r' ! tt akes in OW: x110440tI /*Maw *WI <b* Won amid ditizedteit.101 I to ,.. ., s its dot t tot- � ihor a " to tip►. ine i*mi *Wilma '.' rkeiV of t l etilltiaateAP, 4; ° 4'' - ;( , * .•• I; .1 r • r litocimuteor Nr.14 :Tar 4 .40 YM'b r?...- • ti *In 110000.10011 otta!iiiidkn'as 041,1011: 1`24ior. . . , BUILDING ELeCTRICAL PLUMBING Owner of •_.., Building Architect Contractor or Builder Legal Lot Bl. Description MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 3711 Work to be performed under this Permit Ttus Vic' }' (R ';'�1a 1 You of. . f; ; i f & r� �e Jtd1 be vfd u il r Subdi- �'� this K r prrnut. vision Value of Project DATE . ter/ Contractor's License No. Amt. of i f Permit i -/, ©Q Address of Building 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 bt 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 [INK he assumes responsibility for work done by his agents, servants or employees. �G Signed• C 1 • C By W INS TOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with ali and rrr�gt I4 tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autles of Miami 9hAl'fs� Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. / r i CONTRACTOR OR B UILDER BY AUTHORITY 1941 :i APPLICATION Application is hereby made for the approval of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in com- pliance and conformation with the Building Ordinance of the Miami Shores Village, Florida, and al?'pT'ovisions of the Laws of the State of Florida, all Ordinances of Miami Shores Village, and all rules and regulations of the building Department of Miami Shores Village, shall be complied with, whether specified or not. OWNER o7/OY`tZ Q �� ARCHITECT ‘f2, �. a LOT J BLIC 6 SUBDIVISION4etw.' STRE T ' 96 NEW )(ADDITION REPAIRS NUMBER OF STORIES i ROOF tn= v COST (excluding Architect's fee, landscaping & garage)$ 7 e D d. Building to be used for and no other use„ I hereby submit all the plans and specifications for said building. _ STATE OF FLORIDA) COUNTY OF DADE ) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgment, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the builder of the above described construction, that he has read the foregoing application, and that he did sign the same, and that facts stated by him are true. Read, Sworn and Subscribed before me, Notary Public (Signed) My Commission expires Cubic Feet Cubic feet required in this Block Chairman Member Memnr Secretary ;.� . GL / Building Inspector BUILDING PERMIT RECORD UTAMI SHORES VILLAGE FLORIDA Permit No.,'1 Issued t Signed DATE �� �� . /7.3.? Electrical ermit No. Plumbin r Permit No. B .AR � / r / .e,‹ e' , / / - / _-• / / \ / aV Date Owner's Name and Address M r s . Dora T . Giles Registered Architect and /or Engineer Location and legal description of lot to be built on: Lot— _ Block__ Subdivision 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. Name and address of licensed contractor Lucinan Corporation Street and Number where work is to be done 5 N__B 95th b tr e e t, State work to be done and purpose of building (by floors) Building Allaintenance _and for no ocher urpose. -------- - - - - -- --- - - - - -- - New Building____— _______ —__ Remodeling__ —_ —__ Addition__ Repairs X No. of Stories_ To be constructed of__________- ______ Kind of foundation Roof Covering Estimated Total cost of improvements $_ —_ 675.90 _-____—_— Amount of Permit $ /_1! 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, o work to be performed under this permit, as are licensed by Miami Shores Village. ZyraX. Li man Corporation PAY—(Signed) STATE OF FLORIDA, COUNTY OF DADE. f 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 be is the of the above described construction, that be 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 Disapproved - -___— _____—____._ —__ Date (Signed) PLANNING BOARD DATE Chairman Member _ Member Member - Member Member Council Approved Read, Sworn to and Subscribed before me. Building Inspector My Commission Expires Date Disapproved Date June 19 19 45 N o . A E 9 5th .b' tr e e t 1 N. A. 21s Street, Miami J. E. hohan Office Lanager Notary Public, State of Florida nate 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. BUILDING ELECTRICAL PLUMBING Owner of ) Building / /C t , } //r- Contractor '"*"/ or Builder MIAMI SHORES VILLAGE, FLORID. DATE 194 PERMIT 80 C%acto N. 24 License No. 'Work to be performed under this Permit Architect Legal Lot Bl. Description Address of y Building -�' -� /it Co 2 J 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 appli- cation 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. i Signed:` INSPECTOR In co eration o + e is ance to me of this permit I agree to perfo work covered hereunder in compliance with all or and regulations pertaining - o and strict jiff, •ity with - plans, drawings, state a or specifications submitted tof t proper authori Ie, f iap i Shores Village. In accep ' s perm ass r :.... r+ ...... work done by either myself, my agent, servant or employee. Subdi- vision Value of Project BY Amt. of Permit AUTHORITY Owner of Building i w, M I SHOR VILLAGE, FLORIDA DATE Contra BUILDING ELECTRICAL PLUMBING Legal Lot Description Address of Building This permit is greeted to application herefor in strict with any plans. drawings be revoked at any time if the upon which thla permit 1 the ordinances and that he assumes reap In consideration of the isst any tions pertaining thereto and in r Village. In act this psrmih-1 Architect Contractor or Builder Astroun Onscracto }: with or builder named above 11 ordinances pertaining one that may have been compliance with such that aced ehe contra reby servants or ed- 5abdi- vision WARNtf1G: finis Construction may be in violation of War Production Board Genera! 1 imitations 0 E -41 1ou are cautir;nrd to consult your War P.otiu: ion Board office before starling the work a,>r24 in! this permit. rnie otb the building or to ;install the equipm nt or device described in eto and with the understanding that the woorrkk will be plrforasd in - ubmitted to and approved by the proper municipal authorities. This P Lances or if the plans are anged without authorization. A f rt>mr buikkr named above ass the responsibility fora thorough knowledge r shown on the plans or wihtg or in the statements or sea, the work covered he . <<<, fist cornpliance with all osdinsoess and is or specifications sub tnittec to the proper authorities of Miami !Either myself, my agent, savant of employee. P ID BY YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID RECEIPT NUM BER / / l ( 1940 1941 /D O ° /D Q 4 1 7/8 6 170 /,. / `i/ i i / 0 .� %fie 1942 1943 /Q O DD /d -O d .2 - -$ 0 2-.7 .3 ,a V //fey 1 /A O ad,. j AI --d -61' � . � i� Li . .1944 AO . O / -44t ' 7 - f� ��!! l 7 O 4 � r • / 945 fi .� ✓ z/ ,,_ & A- A 0 i i \14 k ,..GI 1946 1947 12 1 p /�`= dlv 9`/ /7 / 0 13! 0 O / - 1. - 44 4. f y 7—li Yi 3 g4 - pyicir t! U €.1 It t cr �� it If 1948 / T7 iz - / /.. a a t .5/ - 97 /ak7i 'ea. /Q) 1949 42 w /'L /y � /. 7- y9 /.2 777 . /. ��, - A O,/Lif AY-Z.42. / .i J 1950 (/ /d' gi ,5'O �� 716 6 �T o� / �.. LOCATION f 425 N. .L • 95th Litreet (i7 GARBAGE TAX RECORD 425 N. E. 95th St. by year D. G. Sistrunk N annual tax period used 1.7.3/5 / -c /- 5/ amount paid ia_o err) ro receipt_ ] #.59- a 7 FRONT DEPTH ILEIOET STORIES TYPE or, CONSTRUCTION BUILDING TO RE USED FOR ROOF COST OF BUILDING PERMIT FEE " Frame �� •on crete, Stucco Residence. Ants., Stores, Hotel j� �"^ 1� :, ". BUILDING PERMIT No. MIAMI SHORES VILLAGE OFFICE OF BUILDING INSPECTOR Miami Shores Village, Florida, , 193.... Owner of Building • Architect Contractor or Builder PROPOSED LOCATIO e STREET Dated , ✓ , 19 PART OF LOT Lor BLO DESCRIPTION OF BUILDING SUBDIVISION 222 This permit is hereby issued to - � r --- - --- -- =�- _------- - --- -- - -- -- ---------- - - -. —� -- ------ - - - - -- T °----- - - - -�/ - -- the building above described, as per appli tion, Plans altd Specifications heretofore filed in is office. This per t is granted upon the ex- press condition that all facts stated in t e application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and regulations of the building department of Miami Shores Village. This permit may be revoked at any me upon the violation of any provisions of said laws, ordinances or rules and regulations, or rlpeh any change in the plans and specifications 4 uthorized by the building inspector. - -r C - 713 INSPECTOR In consideration of the issuance to me of this uilding permit I hereby agree to do the proposed construction in strict conformity with the application and plans and specifications thereof h etofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the building ordinances and rang laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores Village. (SEAL) PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date M/4/ /a Job Address `t s- e Legal Description /11/ 7 � � 7 /1f cs Owner / Lessee / Tenanald Owner's Address 9 efrif Contracting Co A 1 ,66tQ4rttJ / (r WORK DESCRIPTION 47/ 7/ «� a-c't "c- ( "Cv f iA1 ? 6 ) Square Ft. ciG Signature of owner and /ob Date: IO 141Aj,,AII} td,Lxgsk ;ter Date: OUMMOMIW0' ON PIwO APPROVED: Fire Zoning Building Mechanical Plumbing Tax Folio # Master Permit #,J.50. 7y Phone 757'53/2. Address ( 70 ,". S /'r • / Phone 7 7- 7 7C S Qualifier , -)44-S , -)44-S �4- �a5,�'t, SS ne State # Municipal # Competency # /76&7 � f/ Ins .Co Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Estimated Cost(value)l /? aQ C WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con truction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. re of Contractor o Owner-Builder if 'I'll_ ! : as to Contractor or Owner- Builder Notary as to Owner and /or I8o " rP�"esluenc My Commission Expires: / 1 i-. n.CJ e40 /1?i 2t2u , 011011104,mission PaIlQ soil IMP rIt csi-a nc P Roe rr k l e r CC/70. 93 ** * * * * * * * * * * * * * * * ** Expi MARY FUBUC STATE OF FLORIDA MY COMMIS ON EXP.DEC. 26,1995 BONDED THRU GENERAL INS. UND. FEES: PERMIT /V.-D RADON C.C.F. /iob NOTARY TOTAL DUBJ4•-.50 Other k iiectrical Engineering MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement u, ire plans and specifications herewith submitted for the build • in 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. Date...... v42.e _ 4-S ..._. _...190/ Owner's Name and Address . ./.VO �r 4 Zf . s� 11 N »s. i Stre SS Registered Architect and /or Engineer.... I.QQ(.. ..110/ .11m/ '5 .Q C T1o /P (C.. Ate ,,,,,,,,,,,,,„,t,,..,. l5 S Al.. ._/i� l Name and address of licensed contractor ' .' 1 . . Location and legal description of lot to be built on: L ot Block Subdivision .._..._ ......_..._. _....._._.... »...._ STATE OF FLORIDA, 1 . COUNTY OF DADE. i ss• (Signed) Street and Number where work is to be done State work to be done and purpose of building (by floors) _ »..._........ for no other purpose. New Building Remodeling Addition Repairi No. of Stories To be constructed of land of foundation Roof Covering Estimated Total cost of improvements $.. 300. G Amount of Permit S. 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 ssith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint 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 arc required by the Act. The undersigned agrees to employ only such sy contractors, s* wgrk /o be performed under this pennit, as are licensed by Miami Shores Village. Remuks (Signed) 4- ?.d.../ 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 careful y read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.. 1— Permit No /ZW6 1 1 Date.. /40 ) Read, Sworn to and Subscribed before me. Disapproved �*d�.. .i Date.. Notary Public, State of Florida Building Inspector My Commiuion Expires PLANNING BOARD DATE Chainnan Member _ MIcrober _ 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 Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection at faulty materials anti /or workmanship.