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8199se/2r: 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. Date / ,19 Owner's Name and Addressille_ / ... )14 " 12-0 4 1 41o40?: 2 -1: - SfreeLf 7__Ce ..... Registered Architect and/or Engineer Name and address of licensed contractor______ Location and legal description of lot to b e built n: . .. ______ Subdivision peered Street and Number where work is to be done State work to be done and purpose of building (by floors)___e_.- NOTE: A charge of $1.00 will be made for the Planning Board. A re-inspection fee of $1.00 will be charged materials and/or workmanship. Chairman Member . Member Council Approved __DATE Member Member Member Disapproved Notary Public, State of Florida My Commission Expire_____ and for no other purpose. New Building_ Remodeling Addition Repairs_ No. of Stories To be constructed oL Kind of foundago8_ Roof Covering Estimated Total cost of improvements $ 67 47 Amount of Permit $. "" I • Zone cubage requirecl___ _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 handbag. 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 Worlarien'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 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 or notices as are required by the Act. The undersigned agrees to employ only su bcontractors, k to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. f se• 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. gl ?? Date - _ Read, Sworn to and Subscribed before me. Date making corrections or changes to this application after approval has been obtained from when such re-inspection is made necessary by improper notice for inspection or faulty BUILDING El MIAMI SHORES VILLAGE, FLORIDA ELECTRICAL , ❑ PLUMBING: O PERIVIrr - 8199 ROOFING "p Owner of Building V Address of Work to be performed under this Permit Architect Contractor or Budder .� . Contractor's License No 1 1 Legal Lot Subdi- Description II BI. vision Sq Ft. R. :Oft Building .- , s` a. w. Value of .,. � l Amount of r - - g 4 Project $ + I Permit $ r - Th- is permit permmt cs- � hoa h in strict compliance the—contractor or builder named' above - to construct the building or in till the 'equipmennt or device described in "the applica- 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 tin 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 nbave 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, seivants or employees. 4 Signed:' ' (INSPECTOR) BY In consideration of the issuance to me of this permit I age to perform the work covered hereunde 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. In accepting i�h's permit I assume responsibility for all work clOne, by either, myself, m sere - + t, ; �6r employee.