561 NE 95 St (8)BUILDING, /
ELECTRIC ' 0 P ERMIT 11 13 240
PLUMBING Ei
Architect
Contractor
or Builder
Legal
Description,
Address of
Building
3H/
ROOFING , � ° Work io be performed under this Perini
Owner of
Building
.above to c
This permit is geranted to the contractor or bui
herefor in strict compliance with all ordinances pertaib the an
drawings, statements or specifications that may have been subsaitted
time if the work is not done in compliance with such ordinances or if th
granted is the understanding that the contractor or builder named ebo
pertaining to the work covered hereby whether shown on the o
done by his agents, servants or employees.
In consideration of the issuance to me of this permit
pertaining to and in strict conformity with the plans, d
In acceptin 's permit I assume responsibility for all work
MIAMI SHORES VILLAGE, FLORIDA
Value of
Project $
DA
or to instill the
t the work
t authorization.
for thorough
nts orpecif'
intrac'roR
perform the ,work covered 'hereunder .'f `;: pliance w
atements or specifications submitted to `' proper au
one by either, myself, my agent, 4ervant or employee.
Contractor's
License No
Amt. of
Permit $
ment or device described in
perfornted in compliance
*es. This Permit may be
urther condition upon whi
knowledge of the ordinances
on
applica
h gny' plans,
okerl at any
this permit is
d lations
ilitylor work
ons
ge.
Owner's Name and Address
Registered Architect and /or Engineer.
Street and Number where work is to be done
MIAMI SHORES VILLAGE
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.
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Name and address of licensed contractor
Location and legal description of lot to be b on:
Lot Block Subdivision
E g
State work to be done and purpose of building t� ors)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation____ Roof Covering
Estimated Total cost of improvements $ '...— Amount of Permit $
Zone cubage required E ^/ -Plan Cubage
Distance to next nearest building Size of Building Lot
Date
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) -�
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 Asi
of the above des ibed construction, that he has ¢arefy�y read the forego] application, and that he did sign the same, and that all facts
therein by him fstt . - true
Permit No._
Disapproved
Building Inspector
N
ad, Sworn to and Subscribed before me.
1
ry Public, State of Florida
My om . sion Expires
PLANNING BOARD DATE
Chairman M - • . er
Member ' ember
Member Member
Council Approved Da Disapproved Date
NOTE: A charge of $1.00 will be made for making corre tions 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.