14179MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application 1s 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.
L,&_ te Z° j _
Owner's ___ / s Name and Address • Q' t
No.__ Street____
Registered Architect and /or Engineer
Name and address of licensed contra
Location and legal description of lot to be built on:
Lot
Block
Building Inspector
Subdivision
Street and Number where work is to be done sa-t
State work •, . = done . and p : of building (by floors
New Building Remodeling Addition
To be constructed of___ _ Kind of founded?"
Estimated Total cost of improvements $ /‘
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 for said building. All notices with
be sent to
Repairs__: f No. of Stories_
ping_
.._- Amount of Permit $-_
Plan Cubage
Size of Building Lot__
reference to the building and
The undersigned applicant for this building permit does hereby certify that he understands and acs is his obligations as an employer'
of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws f 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 : the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su • �•� r:_. , o , �� jto be ormed , nder this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) r • ,
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
leered
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.
Permit No. Date
Disapproved Date
(Signed)
Read, Sworn to and Subscribed, before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD _DATE
,19.,,
and for no other purpose.
its construction may
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.
)f
t
UILDING ❑
ELECTRICAL ❑ PERMIT N° 14179
PLUMBING ❑
ROOFING
Owner
Buildin
Architec
Contrac
or Build
Legal
Descript
Address
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE
Work to be performed under this Permit
Contractor's
License No
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. 1
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
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