166 NE 101 St (12)BUILDING
ELECTRICAL
PLUMBING
PERMIT N? 6767
Work to be performed under this Permit
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
As
Legal P Lot lr y ! BBL) 1 n \
Descri tion
' �) 7 1.% J
Address of ,'' / " / 1 7 � � Value of Amt. of
Building °� ! i.- ' Project 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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 clanged without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumess� a responsibility for a thorough knowledge o£'the gr�dinances and •
• regulations pertaining to the work covered hereby whether shown on the plans or drawings or m thestatements or specifications and that he;dssupies respon-
sibility for work done by his agents, servants or employees. .." ;,,,%
CONTRACTOR OR BUILDER
Signed:
Subdi-
vision
DATE 194_
Contractor's
License No.
By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform th6 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 re5'ponsibili y for all work done by either myself, my agent, servant or employee.
‘,4"-"` / _4
BY THORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
PERMIT N? 6767
Work to,be performed under this Permit
CON�exc BUILD ER
MIAMI SHORES VILLAGE, FLORIDA
Subdi-
vision
BY
DATE
7 /
194
AUTHORITY
d"
Contractor's
License No.
Legal Lot Bl.
Description
Address of %' / Value of
" L '�� / � �' Amt. of f r
Building � r/ P rojec t , 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 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 e responsibility for a thorough knowledge of e ordinances and t
regulations pertaining to the work covered hereby whether shown on the plans or drawl s or in a atementsor specifications and th es respon-
sibility for work done by his agents, servants or employees. _ } = � / /
Signed ,,, =1, f ,, >
INSPECTOR
In consideration of the issuance to me of this permit I agree t ferform the yvork- covered hereunder in compliance with all ordinances and egylakions
pertaining thereto and in strict conformity with the plans, drawings, statements specifications submitted to the proper authorities of Miami Sho r i ge;r;
In accepting this permit I assume r nsibility for all work done by either myself, my agent, servant or employee.
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 Sho es Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specif' '0 or not. A copy , • f approved
plans and specifications must be kept at building during progress of the work.
Date
® q0 t � � l! _ ' No.'
Owner's Name and Address
Registered Architect and /or Engineer j
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block ubdivi 'on_
Street and Number where work is to be done _
__and for no other purpose.
New Building �a Remodeling Addition Repairs_ Nv: of Stories
To be constructed of_ •==-1(ind of foundation Roof ring
Estimated Total cost of improvements $___C) 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
1/ cSr1-t
1 __c
a
treet !j Q 5'
G�
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
PLANNING BOA / 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.
and who, being . y me first worn, upon oath d d says that he is " e
of the above described cons on, that he 'Fully r: d the for oin' .pplication, and that he did sign the same, and that all facts
therein by him sate are '
Permit No / /___ Date__ l�___��� / — Read, Sworn to and Subscribed before me.
Disapp ed ____ __ '_'_� __ _____ Date
1 i
( Signed) _ ' , / Notary Public State of Florida
" -
Buildi ' nspectorrV ' v My Commission Expires i
1
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fi
g e e_
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