PAINTMIAMI 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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done y�
State work to be done and purpose of building (by floors) /63 - Y) e 1 • E
Date 7" / S 2__ , 19
No Street
and for no other purpose.
New Building V. Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation
O
Estimated Total cost of improvements $ 1 D Amount of Permit $
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Roof Covering
Maximum live load to be 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. �y�
Remarks ( Signed )711�_It- _ __.e>
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.
ed
Permit No
Pk 4 Date 7' 7 ` - ' Read, Sworn to and Subscribed before me.
Disapproved Date
( Signed)
1 Notary Public, State of Florida
uilding Inspector P. t t.A_) 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 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.
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
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 regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. Jt cop of approved plans
and specifications must be kept at building during progress of the work.
Owner's Name and Address ______
Registered Architect and/or Engi
Name and address of licensed co • t ctor
Location and legal description of lot to be built on:
Lot Block_____ Subdivisi
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
STATE OF FLORIDA, ss.
COUNTY OF DADE.
Permit No.. N
Disapproved _
(Signed)
MIAMI SHORES VILLAGE
Date
Date
BUILDING INSPECTION DEPARTMENT
Date_
Building Inspector My Commission Expires
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
_and for no other purpose.
New Building Remodeling Addition Repairs No. of
To be constructed of _______ _____ Kind of foundation Eovering
Estimated Total cost of improvements of Permit $
Zone cubage required__ Plan Cubage_
Distance to next nearest building Size of Building Lot _
Maximum live load to be 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 cornplied 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)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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.
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 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.
BUILDING
ELECTRICA
'LUMBING
., •
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Work to be performed under this Permit
l i
Lot
PERMIT N? 5660
MIAMI SHORES VILLAGE, FLORIDA
Bl.
,33 R t.99
Amt. o
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 appli-
cation 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 , • r 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 c ge without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assn ere i•onsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or dra is • e statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed.
Subdi-
vision
Value of
Project
DATE
Contractor's
License No.
By
1947
2
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance witl�all. ordinances and, re� ions'.
pertaining thereto and in strict confo ith the plans, drawings, statements or specifications submitted to the proper authori s of Miami S e age,
In acce i ermit I assume tes onsibility for all work done by either myself, my agent, servant or employee.
'7' q \
CON R OR BUILDER `J
BY AUTHORITY
•UILDING
LECTRICAL
- LUMBING
)wner of
; uilding
MIAMI SHORES VILL
PERMIT N° 5660.
Work to be performed under this Permit
•
•rchitect
€I'T1
lontractor
r Builder
.ega1 Lot Bl.
)escription
.ddress of
. uilding
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 appli-
ation herefor in strict compliance with all ordinances pertaining thereto and w'th the understanding that the work will be performed in compliance with any
lans, drawings, statements or specifications that may have been submitted to and approved by the pro • r municipal authorities. This Permit may be revoked
t any time if the work is not done in compliance with such ordinances or if the pl`ns are cha ge . out authorization. A further condition upon which this
ermit is granted is the understanding that the contractor or builder named above`Aassum:. responsibility for a thorough knowledge of the ordinances and
gulations pertaining to the work covered hereby whether shown on the plans or.dra • ' . or ' • ! e statements or specifications and that he assumes respon-
ibility for work done by his agents, servants or employees.
Subdi-
vision
iv; , � ;3 .. _ Project !
Value of'
DATE ? • 194 L
Contractor's
License No.
Amt. of ,
Permit
g
Si ned INSPECTOR By
r►
In consideration of the issuance to me of this permit I agree to perform th work covered hereunder in compliance with all ordinances and regulations
ertaining thereto and in strict confor ith the plans, drawings, statements c ' specifications submitted to the proper authorities of Miami Shores Village.
a acceg'tin ., ,is' permit I assume rps onsibility for all work done by either mys my agent, servant or employee.
'' 14"t rirew
CONTACTOR OR BUILDER
AUTHORITY