925 NE 95 St (2)Permit No
Disapproved
( Signed) .
MOAMO SHOO [ VOLLA C
BUILDING INSPECTION ;.EPA TIVIENT
APPLO(ATOON FOR r.3 L LDDNCc P ° MOT
,ereby made for the approya1 of the detailed statement of the plans and specifications herewith submitted for the build -
re herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
,rida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
.cations must be kept at building during progress of the work.
1
( / Date
No
. �� 1 b t I -Z /1= T / / Street --. //� 7.i •
.ame and Address di, r-
ed Architect and /or Engineer...... f /' L� /� /'� J; =�; \
e and address of licensed contractor Rfiiie____tt4f/ -L -L9 / t' (�y , /‘ g.
Jcation and legal description of lot to be built on:
Lot Block Subdivision/ r 7r/
, 9 Street and Number where work is to be done ' y /T Z � r
State work be done and p,urposc of build' g (by floors) 12t-y:./1 e i / ' / ' 9 ^>' it'e ' -
!-d - i (.f t 9 6 4 — 4QQ 00 c.) ' * f
Date
Date
New Building Remodeling . Addition.
and for no other purpose.
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $. � / 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 su mit all the plagg.and sp ications f staid bI.i1ding. All otices Vith reference to the build its cons r ing and it i may
be sent to
i i� (4 R-✓Ac� l i `� � ` ° L 'fir �� f (: J/ v�°''7� 7-- 1'7!
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 ntractors or sub - contractors employed by him
or notices as are required by the Act. The undersigned agrees to employ only such in the work to be performed under this permit; and will post or cause to be posted for inJtic� on the site of the wo such public notice raci onned under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Repairs No. of Stories
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 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.
77
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Buil.ing Inspec or 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 $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 ❑ PERMIT N9 7777
ROOFING ❑
Architect
Contractor
or Builder
Legal
Description
Lot
MIAMI SHORES VILLAGE. FLORIDA
[� Work to be performed under this Permit
Bl.
Address of 7 Building
CONTRACTOR OR BUILDER
Owner of
Building
Subdi-
vision
Sq. Ft
Value of
Project $
DATE 195
Contractor's
License No
Amt. of
Permit $ ,
7
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