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Po l 113
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of the plans and specificaticms 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.
M1/40Cv"■ Il t°4 - NZPKkek()t:: ij°Nte-L4412 (-
Owner's Name and Address .......
Registered Architect and/or Engineer __Lia0A0— c1/414,0kA
Name and address of licensed confractor$'4it 3i _f'
No No.C) D streetitte_g% _ittakkit.
Location and legal description of lot to be built on:
Lodi ' b Subdivision
Street and Number where work is to be done
we Scwor.S-1/4&...
ParteSit=z-
Sate to be done and purpose of building (by floors)
New Building ' Remodeling_ Addition_ 1 Repairs No. of 4toties
I/
To be constructed of_%1641_4(71... Kind of foundation_ Roof Covering _Ole_
Estimated Total cost of improvements 41- 7trif 0 0 0 — Amount of Permit
Zone cubage required__ _____ _Plop 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 slid building. All notices with reference to the building and its construction may
b sen to Sy5,. 44t." , Lti_o_tLisl,_ILL
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 5966, Compiled General Laws of Florida, P ent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-con loyed 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 public notice
or notices as are required by the Act. The undersigned agrees to employ only su bcontracto on work tq under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed
peared
Council Approved
PLANNING BOARD
_DATE
Chairman Member
Member _______ Member
Member Member
_Date Disapproved
NOTE: A charge of $1.00 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 work
and for no other purpose.
STATE OF FLORIDA,
COUNTY OF DADE. j s
Before me, the undersigned authority, a notary public, duly authorized to administer oaths 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 true.
Permit No. P 4 f "' Date. / It ' 44 Read, Sworn to and Subscribed before me.
Disapproved _____
Da
(Signed) tLt. ers..,9■..
Notary Public, State of Florida
Building for My Commission Expires_
Date
has been obtained from
for inspection or faulty
1 9 0 1 7 5
2 2 0 8 0 0
7 3 4 5 8
9 4 9 0 0
1 5 6 0 0
111250
10600'0
9 0 0 0
2 9 9 2 5
1 0 3 5 0 0 0
4 9 5 0 0
3 3 6 0.0
1 96 9 20 8
1 6 6 0 0
8784,00
9 1 0 0 0
19720 -0
1 1 5 0 0
2 7 3 3 5 0 8
4
r
BUILDING
ELECT
PLUMBRN6 L PERMIT x? 8146
ROOFING {]
Address of
Building
Architect 41
® Co actor
r Budder 4
MIAMI SHORES VILLAGE, FLORIDA 1
Date I' to
Work to be performed under this Permit _- = § ' '
1
Owner of �j, w,
Building
Description
CONTRACTOR or BUILDER
Bl.
Suhdi
vision
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: ' , —1tr.e - w (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, dr swings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work by either, m___ __ ________ employee.
BY
Contractor's
License No
/ 194
Value of Amount of
Project $- 11 Permit $
AUTHORITY