389 NE 99 St (4)F
BUILDING
ELgCTIMAL
PLUMBING
Owner of
Building
Archit
Contractor
or Builder
Legal
Description
Address of
Building
cation h
Lot
In consideratio
pertaining thereto
In accepting th
MIAM, SHORES VILLAGE, FLORID
PERMIT "° 6289
to be performed under this Perris
B
o conStrucf
re or in strict c.nrtpiance wi a8 thereto and with the y._. st
plans, drawings, statements or specifications that may have » : submitted to and a$$mved
at any time if the work is not done in compliance with such ordinances or if the plats are
permit is granted is the understanding that the contractor or builder named above assumes the
regulations pertaining to the work covered hereby whether shown on the plans o
sibility for work done by his agents, servants or employees.
of the iss nce to me
stric 4 `nformity
1 •3 ,! r,spons
•o;
f this permit I agree to p
th the plans, drawings, s
yfor all work done by e
Signed;
DATE
BY
• IN
the work oovered hereunder in compliance
eats or specifications submitted to the proper au
er myself, my agent, servant or employee.
AUTHORITY
Y9
Contractor's
e No
A
Subdi-
vision
Value of , 'Amt. of _ •
Proeot _ Permit
ll the eq'•'ra or (Fevi
he work „ be performed ire
cipal d on .on. A es, , This
iu
for a
•
"`J
P Pfit44
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 complie with, whether herein specified oraut. 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
Name and address of licenskd.. contractor _____________________..
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
Staty •rk to 'e done and purpose of - ldin_ (by 0 ors _
and for no other purpose.
No of Stories -
New Building Remodeli
To be constructed of Kind ou tion___0__ v Roo overing
Estimated Total cost of improvements $ _ e ,\ 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
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 subcontractor on w be performed 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
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 carefylly read the foregoing application, and that he did sign the same, and that all facts
therein by him sti ted ar true.
Permit No ! Date Read, Sworn to and Subscribed before me.
Disapproved
( Sign
netr
to
Bur . ing Inspector
MIAMI SHORES VI LLAG E
BUILDING INSPEPTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date
Date p' l
Str -- --
Addition___ o"
t
Repairs
Notary Public, State of Florida
My Commission Expires
,19_�
to me well known,
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 $L00 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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