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171 NE 100 St (18)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address /'w fie /Q) 15 Tax Folio 1 ,IGQo /5 106o Legal Description Q Owner / Lessee / Tenant HO P &) Master Permit # y,3 �$ 6 Owner's Address Phone LL,,�� Contracting Co. M'l4 r &( X11 e TwC• Address )X731 Alt (t.) • Z2 Sfi• / 1 ilpILE Qualifier / 2 t4) E e2. ss# Phone q.5 41 State # Egooldot Municipal IP7D 2Y776-y Competency # 157sir Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BU ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION c4) • 3/ 2. 7 /47 Square Ft. Estimated Cost(value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S :FFIDAVIT: I ce tify that all the foregoing information is accurate and that all work will be do comp ':nce i h all applicable laws regulating construction and zoning. Furthermore, I auth• a :bov --n:+ contractor to do the work stated. Signatu 'kpwrINOCENadlor . Condo President Signa Date: MYCOmM. Date: % ;F F` BOIL ilru Novi � : : Pl :.. Notary as to Owner and /or Condo President Notary as for or Owner- Builder My Commission Expires: My Commission Expires Z OP • ‘- * * * * * * * * * * * * * * * ** FEES: PERMI ># RADON C.C.F. NOTARY `—® 6 TOTAL DUE �? <( APPROVED: X4 ntractor or Owner- Builder 1 NOCE 0 7" WIRES . , Fire Other �p Zoning Building Electrica 3�rji Mechanical Plumbing_ Engineering_ ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) ON's SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOCK CRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS ANO PRESS PIPING INTERCEPTCR RANGE TCP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNCRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOThES WASHER MOTORS 0— 1 HP STEAM BOILERS SH0W'ER MOTORS OVER 1— 3 HP HOT WATER BOILERS SINK, POT /3 C. MOTORS OVER 3— 5 HP MECHANICAL VENTILATION SINK. RESIDENCE MOTORS OVER 5— 8 HP TRANSPORTING ASSEMBLIES SINK. SLCP MOTORS OVER 8— 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10— 25 If FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS /044. A/C UNIT STRIP HEATER 3' 2, i L9 FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER —NEW INST. GENERATORS TRANSFORMERS ✓' HEATER— REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER —WELL SPECIAL PURPOSE .2 SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE • SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UT I L I TY—SEWER SIGN TIME CLOCK UTILITY —WATER FIXTLRES SEPTIC TANK ,HENNA ' RELAY _. TELEVISION OUTLETS ORAINFIELD. 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA CRAIN ROOF INLET ' SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING ' LAWN SPRINKLER SYSTEM ' GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL PLAN REVIEW COMMENTS DATE: / PROJECT NAME: 5 PROJECT ADDRESS: / / le7/4" S� REV I EWER : /'/ r ae? # La y sA_ SHEET NUMBER: COMMENTS ��i / r 5 L° rz P! �/�� .:: - i�� !11111 Signature of In sector l� / 7 7ff Date Signed J ! (1/4 Title Total Number of Hours (PLEASE TURN IN A COPY OF THIS FORK AS YOUR TIME SHEET: FOR ALL PLAN REVIEW) PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date l 7 16 Job Address 1 / AE /00 s1 Tax Folio p ` 3 2-0 4P /3 (D v Legal Description Historically Designated: Yes No e / Tenant i i i-(0 ex..7e5 Master Permit # i/ 3 5 Owner's Address SA . Phone Contracting Co. P A i /t --P,K cOt h (M )' AA4. Address 2 3 Z Z LA-) - 2 8 s "f Qualifier 2,Q-t/ zv, 2 A Z ss# Phone S - 78 , State # C1 C'4 a-YD Municipal # Competency # Ins. Co. Address Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ' OOFING PAVING FENCE SIGN WORK DESCRIPTION S S 4 -C j A) a 6 3 3 / 7 7 1 - A n , S 4 ( L /v dt) Square Ft. Estimated Cost (value) 3 900" 0 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR. LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all • 1 be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contr or to do th stated. Signature of owner and/or Condo President Date Signature o Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMI Notary as to Contractor o My Commission Expir RADON C.C.F. A ' va NOTARY Date uilder Date BOND q0 TOTAL DUE / D e APPROVED: Zoning f�� Building Electrical 7�� " Mechanical / far Plumbing Engineering Date T 15 Job Address P// AlE /a) /. Tax Polio A( 3 p Legal Description / Lessee / Tenant Master Permit 0 Owner's Address 5 .E- Contracting Co. PA2eeme4T/ Address L32 ?g .51 . Qualifier 12401._ aa�i2.. ss# Phone State /E Aggcipal 0 Competency 0 Ins.Co. * * * Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost(value) 3 (-/DO WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to, obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWN'' FFIDAVIT: I ce tify that all the foregoing information be ••n• n co nce i h all applicable laws regulating const aut e-n d contractor to do the work stated. INOCENCIO a�• Signature of owner and Date: Notary as fl• a-a My Commsion Expi •s: APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Mechanical E GON7Ja� 541313 EC Mr 9 fl 1t48I16119 1 ftlident * 3/2_ Co -o President * * * � r Building Notary My Co Phone dAO /7s d is accurate and that all work will ning. Furthermore, I Signature of Contra for or •:.••r- Builder Date: (� NOTARY TOTAL DUE FEES: PERMIT / )Y - RADON C.C.F. Fire Other Electrical Engineering ITEM BATH TUB UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT CUTLETS CENTRAL HEATING tom,) i lsciO DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) ?)'(a,9U tit 0v DRINKING FOUNTAIN SERVICE SIZE IN AM'S DUCT WORK % T r'" / � FLOOR CRAIN SERVICE REPAIR/1WTER CHANGE REFRIGERATION GREASE TRAP APPLIANCE CUTLETS PROCESS AND PRESS PIPING INTERCEPTCR RANGE TOP UM)ERGROUt) TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 FP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP .. MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION _ INDIRECT WASTES A/C WINDOW REINSPECTII WATER SUPPLY TO: AIR CONEITIONERS '>� ' edi,/ �"� — r "/ V LYi A/C UNIT STRIP HEATER FIRE SPRINKLER .. GENERATORS TRANSFORMERS . 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SW I Mf 1I NG POOL OUTLETS COMMERCIAL WATER SERVICE • SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY _. TELEVISION OUTLETS CRAINFIELO, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECT ION SOAKAGE PIT CU. FT. _ CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL i l7/ r�6 . /6fOS At441-Ad/ Zoe-ae6s /4/0&)e per L, s 3/g 31� ?VV 2 e4 . o?Socr4 roz I e, G. ' 1 5OLf1 SO f #4 /406. X.4 194 09a r 1v Ns SEe/2. /4D — e efe3,'t T,0 3112. tooS JD A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION 98R53457 0 1978 IICT 30 12? 13 PERMIT NO. STATE OF FLORIDA: COUNTY OF DADE: TAX FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: /7/ /ys• , 5k7" $,mil• 33/0g 2. Description of improvement: Name and address of fee simple titleholder: 4. Contractor's name and address: 6. Lender's name and address: 3. Owner(s) name and address: (75V/ 2 ei9e5 Interest in property: C./ce..)/9 C/' /71 q /co 'b A et 6 �/ 4 c 71 7s' / 7(- 3 o /.( 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: iration date is 1 year from the date of recording unless a different date is specified) /.1Jt.041 (f2P,t,GP Notary Public Print Notary's Na My Commission Expires: NOTICE OF COMMENCEMENT Signature of Owner Print Owners Name 0/2 C er2e" Sworn to and subscribed before me this "Z- ' day of dc-7 bex 19 98 . Bonded Thtu (Official Notary t3er rim 1 (800) 723 - 0 i2 i STATE OF FLORIDA, COUNTY O= DADE ER11FY t +•a' this k a tru a of the I HERE AY o'(ic� d of 0 1 ; an } AD 94 ��ioi Seal. W T`Jc' S ^Y h �• y �o F1A:3; RUV1y a Prepared by: 6 /7A rwi Address: Z32? ‘e. g 12301 -52 2193 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot I MIAMI SHORES VILLAGE, FLORIDA ❑ DATE 19 o PERMIT N? 3821 Contractors o License No. ❑ Work to be performed under this Permit CONTRACTOR OR BUILDER Bl la is C. Subdi- vision Value of Project $ ° -:;) 5 . t 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 applica- tion 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. 6 7 1,, Signed' ' -. ' INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all orcihances 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 ac• cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. k .-- ,,� 0 BY AUTHORITY ABBOT PRINT 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 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. Owner's Name and Address' Regis t d Architect ad /or Engineer 1 ere and/or Name and address of licensed contractor 1 1 / 1 --' 2 ' 42-1 ' 11 " Date Building Ins'ector e Date No Location and legal description of lot to be built on: Lot Block Subdivision / Street and Number where work is to be done l 7/ (t/ ` /0 0 ' State work to be done and pur ose of (by floors) �-�''t� -" _.`-' 4 ?/e.,- if A ffft--r� - 7 ..-t, 9D .x and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering o Estimated Total cost of improvements $ ) 3d Amount of Permit $ A 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 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 sub ntractors, on work to be performed under this permit, as are licensed by Miami Shores Village. y � Remarks (Signed) �l 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 stated are true. Permit No 2_ Disapproved ��' (Signed Read, Sworn to and Subscribed before me. Notary Public, State of Florida /d 19' Street 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. BUILDING 0 ELECTRICAL PLUMBING 0 ROOFING C,.. Owner of Building_ Architect Contracto or Builde Legal Descriptic Address Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N? 9469 Work to be performed under this 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 ang that he assumes responsibility for work done by his agents, servants or employees. Signed• 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 responsibility for all work done by either, myself, my agent, servant or employee. • DATE I 4 ,, Contractor's License No 195 BY AUTHORITY Agi&°17. C t ' k te — . • * . 4 ,, ft i - • i„ i g C r- - 4 ii, 4.. i e ,..... t... n Lot Bl. Subdi- vision I / i (, . i f „.-.' ° Sq. Ft Amt. of Permit $ ' 4; Value of Project $, , ,..."'! 4. 4 ; ' BUILDING 0 ELECTRICAL PLUMBING 0 ROOFING C,.. Owner of Building_ Architect Contracto or Builde Legal Descriptic Address Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA PERMIT N? 9469 Work to be performed under this 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 ang that he assumes responsibility for work done by his agents, servants or employees. Signed• 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 responsibility for all work done by either, myself, my agent, servant or employee. • DATE I 4 ,, Contractor's License No 195 BY AUTHORITY Agi&°17. 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 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. Owner's Name and Address._..6;_ei 1/ y Registered Architect and /or Engineer Name and address of licensed contracto Location and legal description of lot to be built on: Lot Block ) Subdivision. / _..._ Street and Number where work is to be done 7/ )i '- / J p State work to be done and purpose of building (by floors) STATE OF FLORIDA, COUNTY OF DADE. J ss Disapproved _ Date__ (Signed) _. But mg Inspector Date )1/ — 3 0 - 19 /2/.._ No h t Street /eo S and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation 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 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 subco a.y., o, work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed 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 stated are " / Permit No Date 16, 2 ° Read, Sworn to and Subscribed before me. Notary Public, State of Florida My mmission Expires PL NING 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. .