1055 NE 96 St (8)APPLI EATD ®N FOR BUILDING PERMIT
Application is hereby made for the approyal 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.
Own r s Name and Address._. -
Regiftered Architect and /or E n g i n e e r
Name and address of licensed contractor_ a'^? 4 — Y it Ak4 02
Location and legal description of lot to be built on:
Lot.. t �- " Block V Subdivision e "
Street and Number where work is to be done- i °4-4.-- . / e:
State work to be done and purpose of building (by floors )./°4e
d
and or no other purpose.
New Building ._._ ___ Remodeling Addition Repairs No. of Stories._
To be constructed of Kind of foundation_._. Roof Covering__
o Cs
Estimated Total cost of improvements $ /o Amount of Permit $ -_
.Plan Cubage. ..
Size of Building Lot
Zone cubage required
Distance to next nearest building__
Maximum live load to be borne by each floor___
I hereby submit all the plans and specifications fin said building. All notices with reference to the building and its construction may
be sent to__ -.-
The undersigned applicant for this building permit doc hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act, being Sec :ion 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, undersigned authority, a notary public, duly authorized to administer oaths and take acki owledgments, personally ap-
peared
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 e.
Permit No C 7 5 Date. _ ^('C
Disapproved ____ _
(Signed)
Chairman _
Member
Member
Council Approved
DAME SHORES VILLAGE
Date_
UILDONG INSPECTION DEPARTMENT
Date... - . , ef7
No __ - .. -.- Street AL �" ?
co
to me well known,
Read, Sworn to and Subscribed before me.
• 72. / t LO
Notary Public, State of Florida
Building Inspector a " My Commission Expires_
PLA ING BOARD
DATE
Member
Member
Member . _._...
_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
ROOFING
Owner of
Building F. `
Architect
Contractor
or Builder
Legal
Description
Address of
Building
t
Lot
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 applica-
tion 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.
Signed- ` -- — ' (INSPECTOR) BY
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.
CONTRACTOR or BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT Np 9495
Work to be performed under this Permit
11 B1. `�
■
Subdi-
vision
Sq Ft.
Value of 11 Amount of {
Project $ 11 Permit $
x
BY
Date
Contractor's
License No. -
AUTHORITY