30 NE 99 St (7)Architect
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORID
PERMIT N?
Work to be performed under
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B1.8 p �
Subdi-
vision
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Signed.
9
CINTRACTOR OR BU
ER
7367
DA
this Permit
Value of
Project
This pe granted to the contractor o uilder name. :.ove to c struct the buil .
cation herefor in strict compliance with all ordinances pertainin_ thereto a. o with the dersta
plans, drawings, statements or specifications that may have been submitted to and app o ed .;
at any time if the work is not done in compliance with such ordinances or if the plan ar c .:n
permit is granted is the understanding that the contractor or builder named above a ,.umes :he
regulations pertaining to the work covered hereby whether shown on the plans or . awing or
sibility for work done by his agents, servants or employees.
BY
INSPECTOR
Contractor's
License No
000-
' a1 ,41 Amt. of
I■ . r1(/ Permit
1944
install the equipment or dev ce described in the appli-
at the work will be performed in compliance with any
per municipal authorities. This Permit may be revoked
out authorization. A further condition upon w ch this
nsibility for a thorough knowledge of the II II " ces and
e st is ecifications and that he . 4 I - respon-
In consideration of the issuance to me of this permit ` e to perform the ork covered hereunder in compliance with all ordinances an
pertaining thereto and in strict conformity with the plans, drawin'• :.r specifications submitted to the proper authorities of Miami S
In accepting 's permit I assume'16 po i ibility for a work done by either myself, my agent, servant or employee.
AUTHORITY
regulations
res Village.
/ l Gt 2 = -<
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r
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Registered Architect and /or
STATE OF FLORIDA,
COUNTY OF DADE.
Member
Council Approved_
Engineer
7
"v
74,11A MI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
.1i
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. A copy of approved plans
and specifications must be kept at building during progress of the work.
Owner's Name and Address ' . A /' % i /1,2P4/1A42 . No. ' ' � Street —L_,'
State work to be done and purpose of building (by floors)
Name and address of licensed contractor ! 12
Location and legal description of lot to b on:
Lot__ Block _ Subdivision
Member
Date Disapproved
Street and Number where work is to be done '"
%
/f _ ' g IQ 3 ) r
__and for no other purpose.
r
New Building a Remodeling Addition P______ Repairs No. of Stories
To be constructed of ___ F`_ _�__ Kind of foundation a =, 46
/
Estimated Total cost of improvements $ V& G C% C' << Amount of Permit _—a'�_ _ _______ ,_ _
. ��
Zone cubage required— � � ' , ; %� "" ' `
.'- Plaa Cubage a
Distance to next nearest building - Size of Building Lot . -- 4
Maximum live load to be borne by each floor Y
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 (Signed),
Disapproved _� !fir a it
;mo t �� , (i� Notary Public, State of Florida
(Signed) f( `
I Building Inspector` ` My Commission Expires
I� JJ- PLANNING BOARD DATE
Chairman _ �. // Member
Member ��� ✓✓✓ Member
A
y
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 d sworn, upon oath deposes and says that he is e
of the above described cons[ rtion, that he : carefully read the foregoing pplication, and that he did sign the same, and that all facts
therein by him stated are t e. ')
Permit No._________ __ _�_ ____ 1 Date ?� �l lr' ' end, Sworn to and Subscribed before me.
.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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