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RESURFACEMIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal 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. Date - _. -- 4.. . - c ,19 b -� l Owner's Name and Address ^ FFo D No 2 ' , / street__.0 ^ `+ / ST Registered Architect and /or Engineer p Name and address of licensed contractor 1 ,t P_! � D_____ v , ivy as Location and legal description of lot to be built on: Lot Block 7-9Subdivision / x ? sI Street and Number where work is to be done State work to be done and purpose of building (by floors) S - C L)gF19 Ce /9 N ~PR A Chairman Member LANNING BOARD DATE Member Member - - - - -- 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 $ / er — 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 S4 #pplenient, 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 perfo ed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) 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. /C)—,2 Date C - Read, Sworn to and Subscribed before me. Disapproved D Notary Public, State of Florida --.'- - -- Ste - Building Inspe j .r My Commission Expires 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 ❑ MIAMI SHORES VILLAGE, FLORIDA �� F ELECTRICAL ❑ Date 19_ PLUMBING ❑ PERMIT N? 10500 Contractor's o,-�s c ROOFING ❑ License No ❑ Work to be performed under this Permit Owner of Building C i A F ' ;) Architect , Contractor i or Builder 10 A ri. U 1 ■ N t CO a ' Legal Lot � Subdi Description I BI vision Sq. Ft. ° Address of t e , 1 — ��� j T V alue of !.' �I Amount of •4 Building ; N t`- _ Project $ t0..„) II Permit $ L' 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 applica- tion 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 thy 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 regulations pertaining to the work covered hereby whether shown on the plans opdeawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, s rv,�,Qts 6Q employees., Signed • - ( " IiSPE OR) BY In consideration of the issuance to me of this permit I agree perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawing atements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done either, myself, my agent, servant yh• employee. A CONTRACTOR or BUILDER BY �L / i L- • t„ J L .