502 NE 94 St (5)Permit No. ___/ �'
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 work.
Owner's Name and Address
Registered Architect and /or Engineer.
Employing Plumber's Name
Location and Legal Description Lot_
Street and Number where work is to be performed —No
/
Amount of Permit $____ • �'
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street
- . -.
0
'
i. . . Y
Block I/ Subdivision ti ✓ ' ..__'... _
J a 0 , 4 / j",.. P` __ � ..ems_
No ___ °__.E' Street__„_
1 x s'
State work to be performed nd purpose of building (By Floors)
New Building Remodeling Addition Repairs
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
r f
(Signed) F= - -=
Date
(Signed) ' - - --
Pl}r nbing Inspector.
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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
//-2, - !I
No. of Stories
Notary Public. State of Florida
Master Plumber.
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 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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT' NS
TOTAL
FIXTURES
CONTR.
LIST
X
/
/
/
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
F IELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR. IST
LIST
—'/—
CHECK
Permit No. ___/ �'
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 work.
Owner's Name and Address
Registered Architect and /or Engineer.
Employing Plumber's Name
Location and Legal Description Lot_
Street and Number where work is to be performed —No
/
Amount of Permit $____ • �'
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly
ss.
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No Street
- . -.
0
'
i. . . Y
Block I/ Subdivision ti ✓ ' ..__'... _
J a 0 , 4 / j",.. P` __ � ..ems_
No ___ °__.E' Street__„_
1 x s'
State work to be performed nd purpose of building (By Floors)
New Building Remodeling Addition Repairs
Size Septic Tank Type of Tank Capacity Gals
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well. Size of Soakage Pit
r f
(Signed) F= - -=
Date
(Signed) ' - - --
Pl}r nbing Inspector.
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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
//-2, - !I
No. of Stories
Notary Public. State of Florida
Master Plumber.
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 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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No
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 work.
r
Owner's Name and Address ___,___„x__ —_, _
— 5 — No . -; Street
Registered Architect and /or Engigeer __7 __ _,,,_.__— __,_ ___— 's` -. -' —...__,.__— ;_'
Employing Plumber's Name ___14.,:__—_--_ — —- ;,. ,' : 1 8 .,-- _ 1 -- el_4_,_ -- Street
Location and Legal Description Lot —_ .___ ________________________Block _. __ Subdivision 4'. ' :'r " •
Street and Number where work is to be performed —No ____ _ .. — Street_..
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By Floors)
Type of Tank._ _
Size Septic Tank
Feet of Drain Tile _ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Wel. Size of Soakage Pit.
(Signed) ______
Date „-� —_
Capacity Gals +.^."
My Commission Expires Notary Public, State of Florida
New Building j Remodeling Addition Repairs No. of Stories
Amount of Permit $__ (Signed)
Plumbing Inspector.
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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
r .
Master Plumber.
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 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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKI
F OUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FI ELD
SOAKAGE
P IT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No
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 work.
r
Owner's Name and Address ___,___„x__ —_, _
— 5 — No . -; Street
Registered Architect and /or Engigeer __7 __ _,,,_.__— __,_ ___— 's` -. -' —...__,.__— ;_'
Employing Plumber's Name ___14.,:__—_--_ — —- ;,. ,' : 1 8 .,-- _ 1 -- el_4_,_ -- Street
Location and Legal Description Lot —_ .___ ________________________Block _. __ Subdivision 4'. ' :'r " •
Street and Number where work is to be performed —No ____ _ .. — Street_..
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
State work to be performed and purpose of building (By Floors)
Type of Tank._ _
Size Septic Tank
Feet of Drain Tile _ Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Wel. Size of Soakage Pit.
(Signed) ______
Date „-� —_
Capacity Gals +.^."
My Commission Expires Notary Public, State of Florida
New Building j Remodeling Addition Repairs No. of Stories
Amount of Permit $__ (Signed)
Plumbing Inspector.
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 com-
plied 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 under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
r .
Master Plumber.
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 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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
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.
Owner's Name and Address._
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Sub
Street and Number where work is to be done -._tP aL• •.�i'' __ ' %- fl.!
. . . ---777 _ ��� ---- ---� �
S to work be don an purpose of building (by floors)
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 $...co.
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, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed
STATE OF FLORIDA,
COUNTY OF DADE. ss
APPLICATION FOR BUILDING PERMIT
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 s y ted are true.
Permit No ` Date 171-- Read, Sworn to and Subscribed before me.
Disapproved Dat �
(Signed) � _ Notary Public, State of Florida
Lt LL' --
Building In3ector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
e� Street__ 97 X42
19
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 made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
,1
4,
Chairman
Member ...._._
Member
Owner's Name and Address. 1
Permit No.
Disapproved
(Signed)
Building Inspector
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 build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores \'illage, 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
Registered Architect and /or Engineer
Name and address of licensed contractor _
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ��„.
State work to be done and purpose of building (by floors)...... I..�.tlL....
•• -•• -- ` 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 $... 8Kl.Q ' Amount of Permit $,..G.r 0 �
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
52 .o Sw ) , uct f
The undersigned applicant for this building pennit 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 fo : cti. on the site : e ork such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su m tr ' ors, on work j. . performed under this
pennit, as are licensed by Miami Shores Village. / /
Remarks._._ (Signed) i .' / ,.I”'
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
`* 19.7
„ _ _........„. No... - ............. Stree Q A/6 9Y 06,
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.
Date... Read, Sworn to and Subscribed before me.
PLANNING BOARD
1 - t
Notary Public, State of Florida
My Commission Expires. ...._...._
_.._ DATE
Member
Member
Member _... „_.._
to me well known,
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 Planning Board.
A re- inspection fee of 51.00 will be charged when such re- Inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Date /�
Permit No ......��.,!..
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 work. a
Owner's Name and Address .ffi
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) Desk... /..%!�-r'
New Building Remodeling Addition Repairs No. of Stories
Sep
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground p P
Type of Installation— Conduit Tubing B.X.L .Metal Moulding
Amount of Permit $
APPLICATION FOR ELECTRICAL PERMIT
-
MIAMI SHORES VILLAGE
c�.
ELECTRICAL INSPECTION DEPARTMENT
ezes
Stiz
No Street
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only suc h subcontractors, on work to
licensed by Miami Shores Village.
STATE OF FLORIDA, l
COUNTY OF DADE. J j
88.
(Signed)
Street
&- g,
O
i-7
Street.O lr'
q41 5 7i7
ectrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
sub-contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
.1. 44 6me
Master Electrician.
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 he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
R ECE'P'T's
FIXTURES
N O. LAMPS
REFRIO.
O UTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. H EAT.
CONN.
SPACE
H EATER
STRIP
H EATER
TOTAL
CONTR.
LIST
/O
( U
CHECK
ENT.
SW.
DIET.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
////����
# /
I /
MOTORS
0.1 HP
MOTORS
I•S HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/'2!
•• �
CHECK
Date /�
Permit No ......��.,!..
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 work. a
Owner's Name and Address .ffi
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No
State work to be performed and purpose of building (By Floors) Desk... /..%!�-r'
New Building Remodeling Addition Repairs No. of Stories
Sep
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground p P
Type of Installation— Conduit Tubing B.X.L .Metal Moulding
Amount of Permit $
APPLICATION FOR ELECTRICAL PERMIT
-
MIAMI SHORES VILLAGE
c�.
ELECTRICAL INSPECTION DEPARTMENT
ezes
Stiz
No Street
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands and a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only suc h subcontractors, on work to
licensed by Miami Shores Village.
STATE OF FLORIDA, l
COUNTY OF DADE. J j
88.
(Signed)
Street
&- g,
O
i-7
Street.O lr'
q41 5 7i7
ectrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
sub-contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
.1. 44 6me
Master Electrician.
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 he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING ❑
MIAMI SHORES VILLAGE. FLORIDA
ELECTRICAL ❑ DATE 195
PLUMBING ❑ PERMIT N? 9076 Contractor s
License No
ROOFING ❑
❑ Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
BI.
Subdi-
vision
Sq. Ft
Value of
Project $
Amt. of
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 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 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 responsibility for work
done by his agents, servants or employees.
Signed • BY
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 authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
44:24'"
Owner's Name and Address
Registered Architect and/or Engineer
Name and address of licensed contractor •
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be one and . rpose of building (by floors)
STATE OF FLORIDA, I
COUNTY OF DADE. Ss.
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 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.
• M. Li) IAA be
Date
New Building Remodeling Addition
To be constructed of Kind of foundation
t>' No 5 $ Street Ai
,19
and for no other purpose.
Repairs No. of Stories
Roof Covering
Estimated Total cost of improvements $ 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, 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)
•
b Ss_ � L /
' / t_ 1_1
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 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 e.
/ v
Permit No / �( 7 Date -f o Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Date
J�� a
rngor
Notary Public, State of Florida
PLANNING BOARD DATE
My Commission Expires
Chairman Member
Member 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 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.
- - -
SO �/E ` S