802 NE 99 St;UILDING
LECTRICAL
'LUMBING
1OOFING
-
❑
.egal Lot
)escription Bl
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT
?wner of
wi lding
Irchitect
:ontractor <.
)r Builder
'address of
wilding
N? 6058
Work to be performed under this Permit
INSPECTOR
Value of j
Project $
DATE
Contractor's
r
License No.
Subdi- •
vision
Amount of
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 application
aerefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime 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
;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
,ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that lief as responsibility for work
- lone by his agents, servants or employees.
BY AUTHORITY
195 /
Signed. _ BY•
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances aitd,regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitteddto the proper authorities of Miami Shores Village In ac-
cepting this' permit I assume responsibility for all work done by either, myself, my agent, servant orimployee.
O
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Owner's Name and Address..
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.
Registered Architect and /or Engineer..
Name and address of licensed contract
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and rpos of building (by floors)
V.-- and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation_.
Estimated Total cost of improvements $_. -, -- 0 -_ 0... Amount of Permit $
Zone cubage required plan Cubage-r-• ��`^
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 pennit 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 sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for • . spection on the to of th work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su actors, \., to ; - performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signe
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 s ted are
Permit No ate orn to and Subscribed before me.
Disapproved /! Date
otary Pu' i State.of Florida
( Signed) 64 -) x
Building nspector My Commission Expires
PLANNI i 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.