1167 NE 99 St (2)BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
e r IN
0•.)- -T.
Owner of
Building
Architect
Contractor
or Builder Od J T g
Legal
Description
Address of
Building
MIAMI
PERMIT N9 5565
4,4 LL
Lot
Bl.
In consideration of the issuance to me of this permit I agree to perform
pertaining thereto and in strict conformity with the plans, drawings, statements
cepting this permit I assume re for all work done by either, my
rr 1 1 t r
CONTRACTOR OR BUILDER
SHORES VILLAGE, FLORIDA
DATA' 41#47 Z 7 195 7
Contractor's II 4"4"
License No.
Work to be performed under this Permit c.i.f.. c .i 440 o 0
Signed. 10
R E r+•. s . i t..tt� A.1 ,..
Subdi-
vision
Value of S
Project
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 application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed In compliance wth any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. '' This Permit may ho sorz,,pired at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further ndition .
'this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledg ..f the ordinw; « , t ilid regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the sfalaments or specificaiio s and that ' - assumes re'wonsibllity for work
done by his agents, servants or employees.
INSPECTOR
the work covered h
cifications su
agent, servant
40.: ; , -;' c s.
BY
;( t.
AUTHORITY
r4
P .4 s.. t f! 1aa
Amount of
Permit $
der hi comptitmce with all ordinances and regulations
d tats the proper authorities of Miami Shores Village. In ac-
trap1 yee.
Owner's Name and Address _. h0._ .14 --
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
and who, being
of di abov.
therein by him
Permit No..
-
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det�siled statement of the plans and specifications herewith submitted for the build-
ing or o her structure her. a described This t-,ilicatic : is made in compliance and con•orm with the Building Ordinance of Miami
Shores Village, Florida, and all prop isions of the Law, c f the Statt of 1.1t:rid., all o d nances of Mi .mi Shores Village and all rules and
regulations of the Building .Diva: 1.11 of :\num Shoi illage -h '1 e ^o pled with, whether herein specified or not. A copy of approved
plans and specificatr. must be ker' at building durin progress of the work.
Registered Architect and /or Engineer _ _ ___
Name ."nd address of licensed contractor
and legal description of lot to be built on:
Lot __. .. Block.._ ___ Subdivision
Street and Number where work is to be done. __f 1.6.
State work to be done and purpose of building (by floors) / ._l_ --4 .x_1` r a
. and for no other purpose.
New Building_ _ Remodeling_. Addition. ✓- . Repairs No. of Stories
To be constructed of _._ _ Kind of foundation _._____ _ __ Roof Covering
D
Estimated " ,tal cost of improvements $._ I Amount c` Permit $ ...
Zone ^ubage required __. -Plan Cubage__... _ _
Distance to next nearest building.. __Size of Building Lot
Maximum live load to be borne by each floor . _ -._
Building Inspe
hereby submit all the plans and speciti.•ations for said building. All notices with reference to the building and its construction may
be sent to -- -- -- - - - -- - - - - - - -- -- - -- --
The undo signed appli ant for th•s hu'lding permit does hereby certify i'iat he understands and accepts his obligations as an employer
of 1 bor under he Florida Workmen's Compensation Act boang S. Lion 3966, Col. pled Gen al Laws of Florida P r.,.ancn. Sappli vent,
and h s compled w'tli he pro,/ 'ions thereof, and will require similar cone: lance from all contractors or subcontractors cmplo •ed by him
in the wo k to be p. rf med under the pern it and ill post or causr to be posted for inspection on the site of the work su.1h public note e
or •otkes as are regwr d by the Act. The u. r ign,•d agrees to employ only such contr ctors, on work to be perform d. .; der this
permit as are licensed by M am. Shores• il!
Remarks.
(Signed) .
sf-
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ,.nd take acknowledgments, personally ap-
peared
by me first d ly cworn, upon oath deposes and says that he is the • de L ibed istruction t. ; 1.. has carefully read the fore ing application, and that he did sign the same, and tl'at .11I facts
stated are trie.
. Date.
-•--• Dat
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Commission Expires_
to me well known,
PLA ING BOARD ____DATE
Chairman _ _ Member
Member Member
Member Member
Council Approved Date Disatproycd Date
NOTE: A charge of $1.00 will be made for snaking corrections er _changes to this application fts•r r.iprovd 11 s 1.0( u r-btau ed from
the Plani•,ng Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is m., it neces,ar) by improper notice fir imp. t o' or 1,u Ity
materials and /or workmanship.
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