1178 NE 98 St (6)BUILDING
ELEC
PLUMBING
Owner of
Building
Architect
Contractor
or Build9
Legal 7,�`
Description
Lot
In consideration of the issuancwtPme. this
pertaining thereto„ in strict cord ity with
In accepti th1s pe it.Ir.0aS5lurre,s sponsibilit
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"' CONTRACTOR O BUILDER,.
MIAMI SHORES VILLAGE, FLORIDA.
DATE ° (A 4L
Contractor
License o.
PERMIT N2 6471
Work to be perform) under this Permit
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Address of ; C ' / J 1 r �` , 1".. f ' r 1 Value of ; �' m '� '' r ° �.. Amt. of °" �'°,,,
S Buildings / r , � i t s .. ,e4 a Project i ' `•+^"""`
This permit is graded to the contractor or ilder named above to construct the 'building or to install the equipment or crevice scribed in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 responsib�'lit for a thorough knowledge p€- dinances and
regulations pertaining to the work covered hereby whether shown on the plans or draw�yrgs or i ,the s)dt ents or specifications and that' e�rss es respon-
sibility for work done by his agents, servants or employees. ,, '
Signed / ` r 1"'°'77... BY
` `Sa15P O o
the work covered hereunder in compliance wall ordinanc rgnlafions
ents or specifications submitted to the proper authorities of Miarhi Shores Village.
er myself, my agent, servant or employee. '
BY
g
AUTHORITY
'Y -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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor .,.__;_ _,:�g _,:,.._ __; -,' > - t . Z ',
Location and leg description of lot to be built or} l '
Lot ") Block a ��✓ Subdivision / -`
/
Street and Number where work is to be done / / `
State work to be done and purpose of building (by floors) ` t 1 ' = ,
Maximum live load to be borne by each floor
STATE OF FLORIDA,
COUNTY OF DADE. j
and who, being by
of the above describ
therein by him stated
Permit No
Disapproved
(Signed).
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ss.
/s SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
ate.
Chairman
Member
Member
Council Approved
nspec r
U
_Date
Date , 19
No Street
' and for no other ose.
New Building emodeling Addition v Repairs No. of Stories
To be constructed of C > Kind of " /4 __ oof Covering , / • ' (L
Estimated Total cost of improvements $_ J / f_ Q ' '� 1 Amount of Permit $� y
Zone cubage required 7 r _ _ _ ___ __ ___Plan Cubage I__
Distance to next nearest building Size of Building Lot
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, 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 thi
permit, as are licensed by Miami Shores Village.
Remarks
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
r r~
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
st duly sworn, upon oath deposes and says that is the
onstruction, that ,he has carefulyread the fo oing application, and that he did sign the same, and that all facts
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
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. -
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