904 NE 96 St (6)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 -
g or ther structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
--� Shores illage, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
ions 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.
Jo'
11 6, 4, 34
Owner's Name and Address____ ail ( r I_h_t_® _ __- ____________ No.S 7 7 S Street CO C �./ vrf.
Registered Architect and /or Engineer
Name and address of licensed contractor___. t'd.lSl _.0 t°! Aire C C . 8 C40., e
Location and legal description of lot to be built on:
Lot___________ _ Block Subdivision
Street and Number where work is to be done _ T
Emote./. e E 4 J ».C ..c�v.'T
State work to be done and purpose of building (by floors)_.Lht___iZig C
and for no other purpose.
New Building ✓ Remodeling Addition Repairs No. of Stories
To se constructed of Kind of foundation Ar• Roof Covering
ca :
Estimated Total cost of improvements $ ,� � .�! C Amount of ,Permit $ �
Zona cubage required_ _Plan Cubage
Dis".aice to next nearest building ___________Size of Building Lot_
Maximum live load to be borne by each floor -
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 5986, 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 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. ss •
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
neared -_-
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 e.
Permit No
Disapproved __ _
(Signed)
Date
Date
PLANN
Fr- 'f-
Date
9'- Z Q_ c .,19
to me well known,
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector `io4 LCommission Expires
BOARD DATE
Chairman ___ ___ f 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 Pl nn in g Board.
"°�` re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by impro;.... : or inspection or faulty
materials and /or workmanship.
MIAMI SHORES VILLAGE, FLORIDA / #i „
BUILDING 0 DATE f 31 / %a
19 u.
ELECTRICAL 0
PLUMBING 0 PERMIT N9 7904 Contractor's /V140_
License No.
0
ROOFAIL
. 0 Work to be performed under this Permit__
Owner of a .. 7.....
Building gm..."---1.-4 g - 4 4 4 L 1— I, i 11 .1 4.. 1.... r ....... AsiCii-' a 4.• 41
Architect 1 _1_, tot 0 a-, ..,......._
Contractor
or Builder a r i,
---)
...
Legal Lot
Description
B1
6 )•14.) 4
CONTRACTOR OR BUILDER BY
I 0 A,
aria "247(
,r■t o. 4.1
Subdi-
vision
414....
ow. —
Address of
/I. 4..— Value of 1 Amount of
Building Project $ 1411:144) 1 Permit $
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 Tesponsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or • the satements specifications a that he assypa respon-
sibility for work done by his agents, servants or employees.
/
Signed. INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with ordinances regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specffications 13u:omitted to the proper authoritie • Miami Shores go. In Go
cepting this permit I assume responsibility for all work done by either, myself, my agefit, seryant or employee.
,
AUTHORITY
Oa"
AllOOT