7445MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Applicaton is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing a, other stru ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Vdlag-, F orida, 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 Mimi Shores Village sh ll be conplied with whether her in specified or not A copy of approv
plans and specifications must e ept at building during progress of the work.
Owner s Name and Addr
)214.
I 1 P Date_ #. 41.2—
at/Mk_ N .A0A4Street_04 M 19A __
o 12
Registered Architect and/or Engineer - - /9 -
Name and address of licensed contractor _
Location and legal description of lot to be built on:
Lot____ _ _ Block Subdivision_
Street and Number where work is to be done. 9W 44 rJ/40Y
State work be done and purpose of building (by floors)_
_ and for no other purpose.
New Building ____ Remodeling Addition_ Repairs_ of Stories
To be constructed of Bind 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_ --------
1 hereby sub .Vall p : i and co 11 l°. or said building. All notices with reference to the building and its construction may
be sent to_ Jr I A-- • k ''' .../ ik
The undersigned appli& i t for • buil 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 5988, 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
permit, as are licensed by Miaii,i Shores Village.
or notices as are required by the Act. The undersigned agrees to employ only such subcon i . .4, i) s, • i i ork to, rformed under this
41
Remarks
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
- _ __to me well known,
andwho,beugbymeffrstdu1ysworn,uponoathdeposesandsaysthat 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
Permit No. _ _ •
4-4-6
te °C e Sworn to and Subscribed before me.
Disapproved _
( Signed)
Member _
Member _ _
Council Approved _
Date
Signed)-
P :
Building Inspector
OARD DATE
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Dine Disapproved Date
NOTE: A rharge of $1.00 will be made for maldng corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-ia.pection fee of $L00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑
ELECTRICAL ❑ � ERM1T N9 ' 744
P
PING ❑ 5
ROOFING _-❑_ - -
O
Owner of
Building ,
teat
Contractor
or Builder
Legal
Description
Lot
CONTRACTOR OR BUILDER
q.G
Work 4 be performed under this Permit 11. F Ca 6 a
ltcldress =s - ', Value o Amount of t..
._ A -
Building
- - - �� � � ` $ x .. a— —` Permif �
This nted is ermit granted i
to the contractor or builder named alma to construct the building or to install the equipm ev'ice described in the applies-
p g
won herefor in strict compliance with all ordinances pertaining thereto with the understanding that the work will be perform mpliance with any
pTans,,-drawmgs, statements or specifications that may Have =teen subinItted to and approved by the proper municipal authorities. This Perms revoked
at any time if the word is not done in compliance with such ordlna -or if the plans are changed without authorization. A further condition upon ich=
permit is named above- _assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the he work c6vered_hereby whether shown on the plans or drawings =or the statements or specifications and that he assumes`respon-
sibility for work done by his agents, servants oYemployees. _ _
_ Co j } ..- 4.--fed It-
" _J INSPECTOR
wo hovered
In consideration of the issuance to me of this permit I agree to' perform the - �°
rk ; hereunder in compliant 'with all ordinaa�s° -and ,regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submits t® proper, authorities of Miami Shores Village =in =ac.
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or : employee. - -
'
. �_
DATE
-2 19
contractor's , I
- License No.
AUTHORITY
7
ABBOT