766 NE 95 St (4)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. 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 �/ e / c e /
Location and legal description of lot to be built on:
Lot Block_ �__ —_ Subdivis o
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Remarks
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved — (Signed) - - -- —
Building
A re- inspection fee of $1
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
/MN No.__. Stree
Date
Date
Inspector
Chairman
Member
Member —
Council Approved__
A charge of $1.00 will be made
the Planning Board.
7
Date
(Signed)
and who, being by me first duly sworn, upon oath deposes and says that be is the
of the above described construction, that he has caref Ily read the foregoing application,
therein by him s ted are t e.
Permit No.
Date-- ______- - - ---
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member _
Member
Member —
Disapproved
J
o
/4/.5;rrte 4 ,4l � "7" ,,,/ e 022
, � _8_,/,'... t &; ?.4 Pte' //7--2 < f )/� - - -- __and for no other purpose.
New Building — ___ —___ Remodeling__ -___ —__ Addition___`_ Repairs No. of Stories_-- -_______
To be constructed of__________ —__ ____ Kind of found tion P _�__ Roof overing____— __— _________ _ _____—
Estimated Total cost of improvements $ e ' --- _______Amount -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 rru�pp1oyer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Per nent Supplethent.
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub -c•• :.to _employed. by' him
in the work to be performed under this permit; and will post or cause to be posted for inspectio, on thesifel • the w.rk such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon ac ars on wor. be / performed under this
permit, as are licensed by Miami Shores Village. -
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared .
to me well known,
and that he did sign the same, and that all facts
_Date
for making corrections or changes to this application after approval has been obtained from
.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
t
_BUILDING
ELECTRICAL
PLUMBING
Owner of ,,
Building
Architect
Contractor
or Builder " o
4 71 r
MIAMI SHORES VILLAGE, FLORIDA
DATE - " 1 -
� 194
PERMIT N?
Work to be performed
5246
under this Permit
Contractor's
License No
21 -J
Legal Lot Bl.
Description
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 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 change authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assts the„rgs'ponsibility for a thorough knowledge of the,orf and
regulations pertaining to the work covered hereby whether shown on the plans or cIrdwmgs .o o th -s riients or specifications he Ames respon-
sibility for work done by his agents, servants or employees. f:r r
A
Signed: ',l!s . / /,�' 6'�; e B (�
" , 7 _ �PECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all -ordinances and giliatiions
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoritie of Miami Shores illdge.
In acpepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONT3&ACTORJOA BUILDER 00 I f BY AUTHORITY
Subdi-
vision
Value of
Project
Amt. o
Permit
P
1
•r-