8205BUILDING 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 hi compliance and conformity with the B Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances' f 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 OEGEM9 M / ,19
Owner's Name and Address_ /_269:0/42 YTE /4ff-- C/41.0 ^/L__ No. 60/ Street~'�t
Registered Architect and /or Engineer ._ A/ Z crAlvoe/e, 5 4J5oeive-s'
Name and address of licensed contractor /7 ED / 14/__C• //o/ K: efdssT- Ce�C,d"�� erl. - --
Location and legal description of lot to be built on:
Lot / TN/ea /a Block / Subdivision // srf_h1�2t s
Street and Number where work is to be done ® Ale 997 aTT State work to be done and purpose of building (by floors) 4/o CP.v.P/,R4w/d co-404w
41 �o.c/��a , ' � j � f® E;Ci�lie/4 E'4a/P6/4-4.//: P rJ, ro00
and for no other purpose.
New Building_ v Remodeling Addition Repairs_ No. of Stories e
To be constructed of__________________ Kind of foundation - ____ Roof Covering_
61 4 Estimated Total cost of improvements $ � � O ®O '''.._Amount 8 _Amount of Permit $____1 ® =1-
Zone cubage required_ __Plan cpbage__
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 5966, Compiled General Laws of Florida, Pennanent 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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work 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 aclmowledgments, personally ap-
Pied
Disapproved -p-- 1 Date
(Signed) _ -- l. ) -r [
MIAMI SHORES VILLAGE
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 r� _ Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
ING BOARD_
Notary Public, State of Florida
to me well known,
__--DATE
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.
BUILDING 0
ELECTRICAL 0
PLUMBING C PERMIT I0 8205
ROOF NG
0
Owner of
Building
t.
MIAMI SHORES VILLAGE, FLORIDA
Datn
Contractor
or Builder? . a iy ±►
Work to be performed under this Permit
Legal Lot l Subdi-
Description I BL vision
Address of
Building `'
- t tor
BY
Value $: , F ` `. 1 A of
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 inn the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or emploiees.
Signe. { ,.: �r� (INSPECTOR) BY
In consideration of the issuance to me of this permit I ag e to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, stateej�nnents or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
P e-
CONTRACTOR or BUILDER
AUTHORITY
77 N E. '7 St
ate., Florid
H. J. ROSS ASSOCIATES; IN C
ENGINEERS
1735 BISCAYNE 13OU6.EMARD
MIAMI. FLORIDA. ;33288
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