OCCUPANCYApplication 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 the work.
Date — 19 C n
*eu' � ►�- 501N0.
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Owner's Name and Address
Registered Architect and or Engineer
Name and address of licensed contractor
STATE OF FLORIDA
COUNTY OF DADE.
Permit No. c- 5
(Signed)
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APPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
tt_S-01>
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New Building .' . ` V Remodeling Addition Repairs
To be constructed of C C Kind of founds on
Estimated Total cost of improvements S 1 501 000Z± Amount of Permit 8
Zone cubage required Plan Cubage L "✓ 11
Remarks (Signed
Disapproved Date
Location and legal description of lot to be built on:
Lot 2 Block Subdivision ` L 3
Street and Number where work is to be done 934 NE
State work to be done and purpose of building (by floors), state ex rior colors (submit mples) _
\ 1\S (..N° Actibt11501,10
and for no j ot her purpose
Size of Building Lot
Roof Covering
No. of Stories.
z o0
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent t
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen',
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 u er is per an will post or cau e to be posted for inspection
on the site of the work such public notice or notices as are required by the Act. The undersigned :e s ..gym oy .n]y s bcontrac .rs. on work to be performed
under this permit. as are licensed by Miami Shores Village.
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared __
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.
Date 1 f 712° 0 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
to me well known.
Council Approved Date Disapproved Date
NOTE: A charge of 825.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship.
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
N° 1965
Miami Shores Village, Florida, e - 1 ' )9 11
Owner, Agent or Tenant of Building LAg WALSR-5 W
Lot 1 FY � Bl l? q1 L g Subdivision _W' M g W R S 5
Street Address L) tt +�
Approved use by occupancy 5 114 G�1. 3 G `�(
Remarks 1
This Certificate of Occupancy is issued to the above named ON.4 )4
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildinas_o n tru ures.
BUILDING DIVISION