1140 NE 100 St' /
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ANNUAL TAX
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DATE PAID
NUMBER RECEIPT
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ADDRESS
1140 )1 . E 100th St
LE Ltl- �' B1 k 178 MS #8
RECORD GARBAGE TAX
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
PERMIT N ?' 4033 Contractor's
License No.
Work to be performed under this Permit
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
r �
DATE
Legal Lot «_, ' B1. Subdi-
Description / f / vision
Address of ; �r �, r R b Value of /
Building / , .� Project
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 appli-
cation 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 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 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 or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees. -
Amt. of
Permit
Signed• jv By
INSPECTOR /
J -
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting t is`p �mit I assume responsibility fora work done by either myself, my agent, servant or employee.
J / 0 1 , L r 0 �;.'r •
BY AUTHORITY
194_4'
1 �
MIAMI S H ORE'S VILLAGE
BUILDING INS'PECNON\DEPARTMENT
APPLICATION FOR B,UiLDING PERMIT
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.
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No ( Date
Disapproved ______ _
(Signed)
Chairman
Member
Member
Council Approved_
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor C-I. --Y
Location and legal description of lot to be bu' t on: �
Lot 7 Block /7 Subdivision_ al ee G A
Street and Number where work is to be
State work to be done and purpose of building (by floors) C
New Building_ ______ ___ ✓ ________�___ Remodeling_____________ ddition ±�6.
To be constructed of ' • ! __ Kind of foundation ��f
Estimated Total cost of impr vemen
Zone cubage required___ /7 ,.0, e2
Distance to next nearest building a 5
Maximum live load to be borne by each floor
I hereby submit a e plans and -,.0%., spec' atiot�s for said building. All notice with reference the the buildin and its construction may
be sent to _-/ -t-- V ! ; ,A
'' >t' - ,. 0 % ., y 1 e'/ e) a � ' ' o <� , z i / .V
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 contr2ors, on work t• b performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Building Inspector
ate
_Amount
and for no other purpose.
Repairs No. of Stories
Roof Covering____!
Permit $� � �f 0_0
24 X
of
Plan Cubage
Size of Building Lot
Before me, the unde ' d
7
authofity, a 9otary, 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
i/ 1 therein by him s ted are true. ..
worn to and Syk before me. `
- -- / 3,___, 19 C�
No. /®K Z Stree � r �
Notary Publi , State of Florida
My Commission Expires
PLANNING BOARD DATE
Member -
Member -
Member
Date Disapproved
to me well known,
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.
c