7238MIAMI 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.
1
g444.4. /
Owner's Name and Address.. 4:144.../.
Registered Architect and/or Engineer
Name and address of licensed contractor--
Location and legal description of lot to be built on;
Lot Block 4/
Street and Number where work is to be done
State work to be done and p • of building (by floors)
New ...... Remodeling, Addition • Repairs.,
To be constructed °L..- ... .. ...... Kind of foundation •
Estimated Total cost of improvements 4'5 6-40 - Amount of Permit $
Zone cubage Cubage
OA /
• ..t"
o..,6A2 Street— 4.,.4
and for no other purpose.
No. of Stories
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 as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors o:L
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
b-contractors employed by him
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on k to be, performed under this
Permit, as are licensed by Miami Shores Village. ,
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, 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 sane, and that all facts
therein by him stated are fruf
Permit No. 7z-
Chairman
Member
Member
777
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Date Disapproved
Council Approved
. .
NOTE: A charge of 0.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re-inspection is made necessary by improper notice
materials and/or worlananship.
to me well known,
Date
has been obtained from
for inspection or faulty
BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOF TC 0
Address of_
MIAMI SHOES
PERMIT N? 7238
Work to be pe,formed -i
Owner of
Building
Architect
Contractor
or Builder ,"S" z; ° `:,�?► aP e,
Legal Lot
Description -
Value of
Building
Project
This permit is granted to the contractor or builder named above to construe the building
herefor in strlct -compliance with all - offices; pertaining °thereto and with the understanding
drawings, statements or specifications that may have been submitted to and approved by the p
time if the work is not done in compliance with such ordinances or if the plans are changed wi
granted is the understanding that the contractor or builder named above assumes the responsib
pertaining to the work covered hereby whether shown on the plans or drawing °} in tie state
done by his agents, servants or employees.
Signed:
In consideration of the issuance to me of this permit 'I agree to perforni the work cover
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications
cepting this permit I assume responsibility for all work done by either, myself, my, agent, sery
k.
CONTRACTOR OR BUILDER / BY
VILLAGE. FLOIRIDA
DATE 195
Contractor's
Zioonse No. . .a
`� Amount of
Permit $
to install the equipment or device described in the application
the work will be perfortned in compliance with any plans
per municipal authorities. This Permit may be revoked at any
out authorization. .A further condition upon which this permit is
ty for a thorough knowledge of the ordinances and regulations
specifions and that he assumes responsibility for work
BY
hereunder in compliance with all ordinances and regulations
tted to the proper authorities of Miami Shores Village. In ac-
t or employee.
'AUTHORITY