ROOFINGMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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.
Owner's Name and Address .11 .. I / A..r t%. ...... _ _ 0.115.8 itreet_/ F .. SL
Registered Architect and /or Engineer.. .... .............. ............. ..... -.. ..
i. ..q.......9` _._.�7.........a.. /...... mss
Name and address of licensed contractor....�,C:'
..f.�LL� . f...... Q a.. n f
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done , /..o.� &....` /__ • 7 '
State work to be done and purpose of building (by floors)
L'..�
New Building Remodeling Re,'60 T Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering 0— /1 9 "'
Estimated Total cost of improvements $ Amount of Permit &. • 0—
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Maxiznum live load to be borne by each floor
I hereby submit all the plans and s for said building. All notices with reference to the building and its construction may
be sent to -.r .A cA, 11 eL?._T f . .1..2 f 9 s .. �j a E-- /Ye *.F__I.... Ll7.
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, Permanent Sup element,
and has complied with the provisions thereof, and will require similar compliance from all coat a • o s or sub - contractors employe by him
in the work to be performed under this permit; and will post or cause to be pos
ted for in ect the site • he work such u c notice
such s}tcoy(tr • ors on w be ., o e under this
or notices as arc required by the Act. The undersigned agrees to employ only pennit, as are licensed by Miami Shores Village.
Remarks-45.A 1- 0 (Signed
SJ .
and for no other purpose.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.._.../ 'S� Z Date t l o / 7 b Read, Sworn to and Subscribed before me.
Disapproved Dat _._........_..
�0 2 ce t-,-.0 �. � � Notary Public, State of Florida
(Signed) C7..±....._ ....
Building Ins Actor My Commission Expires
PLANNING BOARD 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 hecn obtained from
the Planning Board.
A re fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING ❑
Address of
Building
ROOFING ❑
Pa. r CC gyi
Owner of
Building Ca •-4 i
i
Architect
Contractor
or Builder
Legal Lot
Description 131
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE,
PERMIT N? 5830
Work to be performed under this Permit
el (A") PO If
.r. ; ��,s1
Subdi-
vision
Value of .2
Project
Signed' BY:
INSPECTOR
FLORIDA
/
DATE "°++'' ? •1" 195i_
Contractor's A'ts
License No
Amount of.
Permit $
This permit is granted to the contract' . builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinance6,. •Attaining thereto and with the understanding that the work will be performed In compliance with any plans
drawings, statements or specifications that mayve been submitted to and approved by the proper municipal authoriit s Permit may be revoked at any
time if the work is not done in compliance with suv13 ordinances or if the plans are changed without authorization. A fur
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowl
pertaining to the work covered hereby whether shown on the plans or drawings or in the tatements or spec «; tions and
done by his agents, servants or employees.
on upon which this permit is
of th rdinances t &d kegelations
he assures respenstelly fer work
In consideration of the issuance to me of this perreft 1 spree to perform the work co hereunder in compliance with all ordin• and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specificatl* submitted to the 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.
AUTHORITY