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BUILDGIN PERMITSBUILDING ELECTRICAL 1.UMBING owner of 4 4 a.. uding } Architect:''/ Legal Lot :3escription pertaining thereto and In a Contractor . of Builder ! cf o,4 #1/ R OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N? 6597 Work to be performed under this Permit Co± License € lj �r .•I.L etsel Bl. vision Value of Pro Address of f a g This permit is granted to the con • actor or der nam above to construct the building or to install the equip.' cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will -plans, drawings, statements or specifications that may have been submitted to and approved by the pr • • municipal au=_ .at any time if the work is not done in compliance with such ordinances or if the plans are changed wi , t authorizatioa permit is granted is the understanding that the contractor or builder named above assumes the r • ,, 'ty f a :emula pertaining to the work covered hereby whether shown on the plans or, dra or in is or 1._' ty for work done by his agents, servants or employees. � ' 4 1a �t Signed* — In consideration of th issuance to me of this permit I agree to perfo a work covered hereunder in compliant ct conformity with the plans, drawings, sta s or specifications submitted to the prop:; e respcsibility for all work done by either myself, my agent, servant or employee. BY Disapproved _�ll_.� .... ®.� Date (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION 0 APPLICATION FOR BUILDING PERMIT Application is hereby umdc for the approval of the detailed statement ut ore 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. Date / "I 4 X -l __. —. _ — _..._. ,19. 7/ Owner's Name and Address 14, /71. il Ala e yiff,s _ No.. 'Y' Street— fV Registered Architect and /or Engineer .,....,,TI .................. Name and address of licensed contractor VP of 4 .1‘4) 4, in y ee` .. - P/C — Location and legal description of lot to be built on: Lot Block Subdivision Q 44.0 A..., .;t) — _.. ® .5 7 i ei le iep Street and Number where work is to be done State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition )( Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ "' Amount 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, anti 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 arc required by the Act. The undersigned agrees to employ only such subcon. : ors, on work to be pgformed under this pertnit, as are licensed by Miami Shores Village. Remarks (Signed) EPA RTPflENT ) 2 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 carefull read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. A � - Permit No..__.'wY. -l. Date Read, Sworn to and Subscribed before me. Notary Public, State of Florida Building Inspector 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 Plannihg Board. A re in fee of $1.00 will be charged when such re- inspection fie made necessary by impropce notice foe inspection or faulty materials and /or workmanship. t l . / 1941 ///:// tors No 47 ,) trit fw s -( 76 j ent or device . escribed in the appli- e performed in compliance with any orities. This Permit may be revoked A further condition u hich this h knowledge of "` "" and cations and +� respon- 1 with all ordinances and regulations r authorities of Miami Shores Village. INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION PERMIT NO. DATE FEE TEMPORARY SERVICE S f7EAMS & LINTELS SEPTIC TANK - S S SEWER FRAMING S SOLAR HEATER S S GAS S S S S FINAL DATE BY RE- INSPECT BY RE- INSPECT BY CLEAN -UP ROUGHING CONTRACTOR PHONE PERMIT NO. 1 DATE FEE 5 NEW BLDG. ALTERATION I ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE S S SEPTIC TANK - S S SEWER S S SOLAR HEATER S S GAS S S S S 1 INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY .2OUGHING ROUGHING GAS H. W. HEATER CONN SEWER RANGE CONN. SEPTIC TANK SOLAR HEATER FIXTURES & FINAL FIXTURES CONTRACTOR PHONE PERMIT NO. DATE FEE S NEW BLDG. I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE S H. W. HEATER CONN. S RANGE CONN. S MOTORS S FIXTURES S S INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL. TO POWER CO. FOR SERVICE DATE BY OWNER'S NAME SPORTING 'U. L. IT'VDERSON (LEE'S) GOODS PRESENT ADDRESS LICENSE NO. PHONE NO. JOB LOCATION (ST. OR AVE.) 214 ATE 98th Street LOT BLOCK SUBDIVISION GENERAL CONTRACTOR - ADDRESS PHONE NO. LICENSE NO. BUILDING PERMIT NO. 659 / Crary DATE 6/1/48 PERMIT FEE $ 2.50 BUILDER'S BOND NO. DATE ZONE PEQU I REM ENTS CU. FT. PLAN CUBE CU. FT. EST. COST $ DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: DATE NEW CONSTRUCTION TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION REPAIRS DESCR IPTION ALTERATION DESCRIPTION Install counters and partitions in store X ADDITION SUBMITTED TO PLANNING BOARD APPROVED REJECTED REFERRED TO COUNCIL REASONS RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REMARKS ! ' CERTIFICATE OF OCCUPANCY NO. ISSUED BY • TO MY BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE OWNER'S NAME MIME SHORES INV. COJFABRIC SHOP) BUILDING PERMIT NO. ZONE JOB LOCATION (ST. OR AVE.) 212 NE 98th Street GENERAL CONTRACTOR I• NEW CONSTRUCTION REPAIRS ALTERATION ADDITION SUBMITTED TO PLANNING BOARD RE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL DATE ^EOUIREMENTS CU. FT. DRAWINGS. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: TYPE STORIES ROOF CONSTRUCTION APPROVED CERTIFICATE OF OCCUPANCY NO. ISSUED REJECTED LOT PLAN CUBE PRESENT ADDRESS PERMIT FEE $ REFERRED TO COUNCIL BY ADDRESS BLOCK DESCR IPTION DESCR PTION TO CU. FT. REMARKS LICENSE NO. EST. COST $ BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE SUBDIVISION PHONE NO. BUILDER'S BOND NO. DATE INTERIOR CONSTRUCTION REASONS PHONE NO. LICENSE NO. DATE INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION PERMIT NO. DATE FEE TEMPORARY SERVICE BEAMS & LINTELS SEPTIC TANK S SEWER FRAMING S SOLAR HEATER $ GAS S . $ FINAL DATE BY RE- INSPECT BY RE- INSPECT BY CLEAN -UP CONTRACTOR PHONE PERMIT NO. I DATE FEE $ NEW BLDG. I ALTERATION ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ SEPTIC TANK S SEWER S SOLAR HEATER $ GAS S . $ INSPECTIO •IS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING GAS SEWER SEPTIC TANK SOLAR HEATER FIXTURES 5/21/48JDH CONTRACTOR E C Cornelius PHONE FEE $ 1.00 L PERMIT NO. 653 DATE 5/18/48 NEW BLDG. Stor ALTERATION ADDITION R'cPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ROUGHING H. W. HEATER CONN. RANGE CONN. FIXTURES & FINAL 5/21/48JDH BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS ELECTRICAL PERMITS & INSPECTIONS APPROVAL TO POWER CO. FOR SERVICE DATE ?wner of uilding V - /4 I rchitect ntractor Builder dal Lot escription — ddress of ilding T c,- 75+~'°`— _,� , 2 i ' { MIAMI SHORES VILLAGE. FLORIDA =UILDING ❑ LEcTB.ICAI. ® 'LUMBING PERMIT 11T° 4254 ❑ iOOFING ❑ Subdi- Bl. vision Value of Project $ DATF Contractor's License No. Work to be performed under this Permit Amount of Permit $ This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application =refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, swings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any le 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 anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work ne by his agents, servants or employees. Signed' ; INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- ting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY 195 6 MIAMI SHORES VILLAGE APPLICATION FOR ELECTRICAL PERMIT Permit No._______ — _,/� --- r- - - - - -- Date _ 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 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 work. � ! � Owner's Name and Address fttt ��e ,Iysr % (+E� �Fifil 1 _---- _-- - - - -_. Street = X 27 ELECTRICAL INSPECTION DEPARTMENT Registered Architect and /or Engineer Employing Electrician's Name Location and Legal Description Lot Block Subdivision _______________________________ Street and Number where work is to be performed —No Street State work to be erformed and purpose of building P P P 8 (By Floor I ^ �'. - • - - -�= r= - --�.! �_ ' `�'' �?'( -/- -_= �'_` - =- �°!""�j/ New Building Remodeling Addition. Repairs —___ No. of Sdbries______________ Amount of Permit $_ appeared Street Service Overhead Size Feeders Conduit____ —_ —___ Main Sw —____ Amps. Main Fuses________________Amps. Underground Type of Installation— Conduit Tubing B.X.L. .Metal Moulding The undersigned applicant for this building permit does hereby certify that understands and accepts his oblig ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled eneral Laws of Florida Permanen Supplement, and has com- plied 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 under signed agrees to employ only such sub - contractors, o� work to be performed under this permit, as are licensed by Miami Shores Village. ,. r ' t �.- , (Signed) Electrical Inspector. (Signed) M ter Electrican. STATE OF FLORIDA, 1 COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO.LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST / CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS O -I HP MOTORS 1-5 HP NEON TRANS. RADIO TOTAL. CONTR. LIST CHECK MIAMI SHORES VILLAGE APPLICATION FOR ELECTRICAL PERMIT Permit No._______ — _,/� --- r- - - - - -- Date _ 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 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 work. � ! � Owner's Name and Address fttt ��e ,Iysr % (+E� �Fifil 1 _---- _-- - - - -_. Street = X 27 ELECTRICAL INSPECTION DEPARTMENT Registered Architect and /or Engineer Employing Electrician's Name Location and Legal Description Lot Block Subdivision _______________________________ Street and Number where work is to be performed —No Street State work to be erformed and purpose of building P P P 8 (By Floor I ^ �'. - • - - -�= r= - --�.! �_ ' `�'' �?'( -/- -_= �'_` - =- �°!""�j/ New Building Remodeling Addition. Repairs —___ No. of Sdbries______________ Amount of Permit $_ appeared Street Service Overhead Size Feeders Conduit____ —_ —___ Main Sw —____ Amps. Main Fuses________________Amps. Underground Type of Installation— Conduit Tubing B.X.L. .Metal Moulding The undersigned applicant for this building permit does hereby certify that understands and accepts his oblig ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled eneral Laws of Florida Permanen Supplement, and has com- plied 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 under signed agrees to employ only such sub - contractors, o� work to be performed under this permit, as are licensed by Miami Shores Village. ,. r ' t �.- , (Signed) Electrical Inspector. (Signed) M ter Electrican. STATE OF FLORIDA, 1 COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING Owner of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE = + i 194_Lc PERMIT N? 8992 Work to be performed under this Permit Architect Contractor or Builder Legal Lot Address of ) i Value of Amt. ofs r� Building N 1 .�' f Project I 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 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 responsibility for a thorough knowledge of the ordinances and tions pertaining to the work covered hereby whether shown on the plans or ,drawings or in the statements or specifications and that he assumes respon- si ty for work done by his agents, servants or employees. , Bl. By - f INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all drftlinces and' regulations n perta iniug thereto and in strict conformity with the lans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. II accee this permit I a responsibility for g work done by either my my agent, servant or employee. Subdi vision BY ,.. 1 Contractor's License No. AUTHORITY Permit No 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 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 work. Owner's Name and Address U .No Street . ..... ..., Registered Architect and /or Engine j �f Employing Electrician's Location and Legal Description Lot ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date 1G1 Amount of Permit $ 3 (Signed) STATE OF FLORIDA, 1 COUNTY OF DADE. I ,6. MIAMI SHORES VILLAGE No...,.`� Street.. /? j.. Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation —Conduit Tubing B.X.L Metal Moulding ectrical Inspector. 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 subcontractors 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. /,' t' R aster Electrician. Before me, the undersigned authority, a notary public, duly authorized 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. to administer oaths and take acknowledgments, personally My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'7's FIXTURES NO. LAMPS REPRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SZACE WATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. ��' /C/ 6/� —A ` 1 /' � a / it MOTORS 0.1 HP (i G� MOTORS 1•0 HP NEON TRANS. RADIO TOTAL CONTR. LIST . ' '9 l� --, CHECK Permit No 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 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 work. Owner's Name and Address U .No Street . ..... ..., Registered Architect and /or Engine j �f Employing Electrician's Location and Legal Description Lot ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date 1G1 Amount of Permit $ 3 (Signed) STATE OF FLORIDA, 1 COUNTY OF DADE. I ,6. MIAMI SHORES VILLAGE No...,.`� Street.. /? j.. Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation —Conduit Tubing B.X.L Metal Moulding ectrical Inspector. 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 subcontractors 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. /,' t' R aster Electrician. Before me, the undersigned authority, a notary public, duly authorized 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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. to administer oaths and take acknowledgments, personally My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Owner's Name and Address MIAM�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. it, 11 • 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 Remarks (Signed)_ Date No. or notices as are required by the Act. The undersigned agrees to employ only such su tr�s, o or permit, as are licensed by Miami Shores Village. ` Street / Notary Public, State of Florida 19 Sta {vork to be done and purpose of building (by floors) ____ ; �_j__ ' � a and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ ______: _Anpunt 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 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 gf y)Ae work such public notice be performed under this 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. � r Permit No Date � Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector 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.