335 NE 101 StMIAMI SHORES VILLAGE, FLORIDA
BUILDING
ELECTRICAL ❑ PERMIT N9 9409
, LUMBING ❑
OOFING ❑
Iwner of
uilding
rchitect
antractor
Builder
'gam Lot II Bl.
ascription.
ldress of
Iilding .,. : ?
CONTRACTOR OR BUILDER
DATF r ' ,
Contractor's
License No
Work to be performed under this Permit _j < 1- •
Subdi-
vision
Sq. Ft
Value of
Project $
Amt. of
Permit $
195
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
i refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
c wings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
e 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
u ted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
rtaining 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
ne by his agents, servants or employees.
Signed- : r• �.gy
INSPECTOR .
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with alF.grdinances and regulations
taining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
f
BY AUTHORITY
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._ Imo 4 r • N'......) it 4. L , ✓ .P. No. Street 4 4 CF, /...D./ f �•
Registered Architect and /or Engineer /o
Name and address of licensed contractor 1 •q • 1 0_ ,C .G FF frA e • / 3 a ' 6 W. _.. 0 .e= ,44‘,/ ,
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done e .5 4 C am • / 0
State work to be done and purpose of building (by floors)
6 C q C •E C19: E oK E 4 ..: W. 41 O o w ,I' r ie, Te,/ ,9 p/ Gi9 eAd ad • 7 —
Aft r
and for no other purpose.
rew Building Remodeling. Addition / No. of Stories
To he constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ >r.d • Amount of Permit $ S. 0 d
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 pennit 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 Stif >lement,
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 ' • . ection he site of ork such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such s c on w• to rfo`im under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) '
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
and who, being by me first duly swor , upon oath deposes and - says that he is the
of the above described construction, t at he has carefully read the f regoing application, and that he did sign the same, and that all facts
therein by him stated are true.
IQ ) Permit No 7' C
Disapproved
(Signed)
Notary Public, State of Florida
Building In ector My Commission Expires
PLANNING BOARD DATE
Chairman
Member
Member
Council Approved
Date
of $1.00 will be made for making corrections
OG 7
Date . / r , 19 5
to me well known,
Read, Sworn to and Subscribed before me.
Member
Member
Member
Disapproved Date
or changes to this application after approval has been obtained from
NOTE: A charge
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.