1199 NE 99 St (12)•-'
Name and address of licensed contractor ll
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
State work to be e a o p . ose of building (by
STATE OF FLORIDA,
COUNTY OF DADE. ss.
and who, being by
of the above descri
therein by him toatee
Permit No.__ _
Disa ped 1.
(Signed)
Chairman
Member
Member
'ouncil Approved
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-
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.
C---' Date 1Pi LcZ& ,19-4 r
Owner's Name and Address 4/9NC/it I E,cS.L. _ No., Q_ — Street___
Registered Architect and /or Engineer if 1 '
If 01.41 i
Subdivision_
New Building Remodeling Addition =– v Repairs No. of Stories
To be constructed of___C1 <�lt'�y.l rid of fo dation Roof CQverin
Estimated Total cost of improvements $ , Amount of Permit $ °—
Zone cubage required 1 .Plan Cubage
Distance to next nearest building _Size of Building Lot
Maximum live load to bb -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, 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
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments; personally ap-
peared
e first duly sworn, upon oath deposes and says that he .is: the
ed constructio that he has car fully read the foregoing application, and that he id sign The same, aid that all facts
l are true.
Date
Building Inspector
PLANNING BOARD
_Date
NOTE: A charge of $1.00 will be made for making
' Board.
(Signed)
and for no other purpose.
Read, Sworn to and SubscribeH before me.
Z ' o z . ‘
DATE
to me well known,
7E
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
corrections or changes to this application after approval has been obtained from
-e- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
and /or workmanship.
ic 2"
-r--- .
Pey _
- Lc_
_,141
k 6 1/
1
•
BUILDING -
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
PERMIT NT 6447
Work to be perf =r 3. =d under this Permit
Legal Lot II Bl . Sub
df-
Description vi
Address of r ,f V
Building tr .r P
This pe it is _ranted to Wider named above to construct the
cation herefor in stric compliance w h or R `a emcee p ertaining thereto and with the enders
plans, drawings, statements or specifications mat ma ' have been submitted to and arp by
at any time if the work is not done in coraplianee such. ordinances or if they _
permit is granted is the understanding that the cbntmetor or builder named tab
regulations pertaining to the work covered hereby s►hether shown on the plans
sibility for work done by his agents, servants or yees.
a
It `
AMI SHORES VILLAGE, FLORIDA
4 DATE ! �+ . " 194
In consideration of the issuance to me of this permit I agree to p
pertaining thereto and in strict conformity with the plans, drawiuys,
Iii accepting this permit I assume responsibility for a work done by eiihe
has the
Contractor
License No.
the work covered hereunder in compliance
or specifications submitted to the proper
self, my agent, servant or employee.
ent
BY - AUTHORITY
1