1195 NE 100 St (2)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
LI
❑ PERMIT N? 15927
❑ Work to be performed under this Permit
BL
Subdi-
vision
Value of
Project $
DATE 195
Contractor's
License No
Amt. 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
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 responsibility for work
done by his agents, servants or employees.
Signed • m BY
INSPECTOR
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 this permit I assume �, for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BDER BY AUTHORITY
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 oilier structure herein described This applicatio t is made in compliance and comorm.ty with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws cf the State: of F1„rid.a. all oid•nances of Mi.inu Shores Village and all tines and
regulations of the Building Divs:.inn of ' iiami Shon 1 iilage -h , '1 ';e t with, whether herein specified or not. A copy of approved
plans and specifications must be keje at building durin,_ progress of the wcrk.
Date -2e." a 3® Ty' ... 19
Owner's Name and Address No Street
Registered Architect and /or Engineer.
Name and address of licensed contractor __.__d A
Location and legal description of lot to be built on:
MIAMI SHORES VILLAGE
Lot. Block... ___ Subdivision
Street and Number where work is to be done_. /L 7) .�,__._..e__� .a
State work to be done and purpose of building (by floors)
Chairman
Member
and for no other purpose.
New Building____________ _ Remodeling_. ____ ___. Addition._.. __ ___ __.__ _.._ Repairs_. - _ No. of Stories
To be constructed of. Kind of foundation _._____ _.___._ ___. Roof Covering._ . -
Estimated " ;tal cost of improvements $_ d6 c
__. d. Amount o: Permit $.
Zone cubage required. __. _Plan Cubage -
Distance to next nearest building__ .._ Size of Building Lot
Maximum live load to be borne by each floor
hereby submit all the plans and specilic•ations for said building. All notices with reference to the building and its construction may
be sent to .
The undo signed appli .ant for this building permit does hereby certify That he understands and accepts his obligations as an employer
of 1• bor under he Florida Workmen's Compensation Act bung S, -tion 598ti, Compiled Gen -al Laws of Florida. P r. an.n, Supply new.,
and h s compled with the provisions thereof, and will require siriiiar come fiance from all contractors or sub- - .,ntractors cinplo•.•ed by Hint
in the wok to be p ri : -coed under this permit: and ill post or cause to be posted for i ection on the site ?the work sit - public noti, c
or i.otices as are requir d by the Act. The u. dt r ign •d agrees to employ only such :fib i r. ctors, on 1 .'or . o be perform d .: der this
permit as are licensed by M am Shores N. ii':,ge.
Remarks_
■
Permit No______
Disapproved
(Signed)
Member _
Council Approved
Date._
Date
Building Inspector
NOTE: A charge of $1.00 will be made for
the Planntng Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
BUILDING INSPECTION DEPARTMEN
(Signed) -
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally pp-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the ._. .
of tli abov. de.vibed istruction t..: h. has careially read the foregoing application, and that he did sign the same. and that .11 ;acts
therein by him stated are tr ie.
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Commission Expires.
PLANNING BOARD
Member
Member . ___ _
Member
_Date Disapproved _ Date
making corrections or ;;hinges to this application .:ftt•r approval his be n i•htarned from
DATE
to me well known,
when such re- inspection is m;. ii• necessar} by improper notice four inspi t•ni' or Le. ity
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