444 NE 96 St (6)Chairman
Member
Member
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.
Owngr's Name and Address W _ /L• _ _ /7_ /9 L!e-
Registered Architect and /or Engineer
Name and address of licensed contractor e / 9 /9/,tJ
Location and legal description of lot to be built on:
Lot Block
State work to be done and purpose of building (by floors
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to
peared
Date /l -- c%
ate
Subdivision
Date_
Street and Number where work is to be done W.g �'rs�___,5T
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 $ 7 � ' �� 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 doe:. 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 contracto or sub contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for insp-ction o. t.e site of the wo k such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su for o. , ork to be - erformed under this
permit, as are licensed by Miami Shores Village.
Remarks__ _______ . - — _ -. -- ( Signed )
administer
// -/337
No. 4 Street 9eST die
C�ii 74I
oaths
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
o
,19
and take acknowledgments, personally ap-
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 tr
Permit No.__.__Q __
Disapproved / I
(Signed)
Building I ctor
PLANNING BOARD._ __ . DATE
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.
A
1Y/ sr
4
From: Village Manager
To:
4ianii cSW oz&. ' MLtaaz
F L O R I D A
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Date
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bui ding Inspection Request
Name
Address
Company
Phone #
Inspection Date 5
Correction
Re- Insp'n Fee
Type Insp'n (nal 1 nW Q
Permit No. f5! 05"'G-} ot.sulticz.
444 NE gcos)-
FT-LP' -
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
ELECTRICAL ❑
PLUMBING ❑ PERMIT N? 9403
ROBING ❑
!mss !T iVa., /'
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
II Bl
Lat
CONTRACTOR or BUILDER
Work to be performed under this 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 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 t plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
r r
Signed• ( a 746 (INSPECTOR) BY
In consideration of the issuance to me of this permit ree to perform the work covered hereunder in compliance with all ordinances and regulation;
pertaining thereto and in strict conformity with the plans, dr ' ings, 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, � y agent, servant or employee.
Subdi-
vision
Sq Ft.
Value of � f Z S I I Amount of / .. " 4.".
Project $ 11 Permit $
BY
Date— / • r ,967
Contractor's
License No.
440 .77/1
AUTHORITY