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121 NE 100 St (5)BUILDING ELECTRICAL PLUMBING Owner of Building Lot v Work to be performed under this Permit MIAMI SHORES VILLAGE, FLORIDA DATE 4/ PERMIT N° 7921 Contractor's License No Architect Contractor or Builder Legal Description Address of f , Value of-- F Building i; 0 � Project - a 00 et This permit is. granted o 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 oy- drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. /• 16,..-...,,...ee i t Signed' In consideration of the issuance to mg of this permit I agree to perform the ork covered hereunder in compliance with a��11 o pertaining there nd in strict conformity With the plans, drawings, statements o specifications submitted to the proper authdfltEtes In accept " +•'t I ass e responsibility for all work done by either my6, my agent, servant or employee. Bl. Subdi- vision BY , AUTHORITY 194 nces and e�oris� iami Sh s ge.- Location and legal description of lot to be built on: Lot Block Subdivision_ STATE OF FLORIDA, COUNTY OF DADE. ss. Building Inspect MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 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 S; ores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein spe .ed or not. A copy of approved plans and specifications must be kept at building during progress of the work. AS Date Owner's Name and Address ^ , `A7a No Street Registered Architect and /or Engineer Name and address of licensed contractor Date_ r Street and Number where work is to be 'done State work to be and p ose of building (y floors)_ kt • YA1_,i� 4.17 4"- �� X _�. Date �+ and for no other purpose. New Building Remodeling Addition Repairs To be constructed of Kind of fou dation Roof Covering Estimated Total cost of improvements $ / 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 to 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 ins. • ion on the site of the • su11 public notice or notices as are required by the Act. The undersigned agrees to employ only • sub _�i ors, • • s •e performed under this permit, as are licensed by Miami Shores Village. Remarks (Sign Before me, the undersigned authority, a notary public, duly authorized to a ini r 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 d s ribed co • •tion, that he has cayefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated ar ead, Sworn to and Subscribed before me. Notary Public, State of Florida No. of Stories My Commission Expires 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.