489 NE 101 St (11)MIAMI SHORES VILLAGE
A1`l'lication is hereby made for the approval of the detailed statement 01 rile 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 /4#
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date..
___..
No
1 f Street...t' e P.L_....... �.
Registered Architect and /or Engineer .... .........
tv..ot RElL Co Ai % & _ 3 6(/ s !'r t•9„3
Name and address of licensed contactor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done tiff X" E
State work to be done and purpose of building (by floors)
o
r s. . r 9 e} e CF S ri r
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of found ttion ,( Roof Covering
Estimated Total cost of improvements $ 1- Amount of Permit 5.....t!,�s.
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
\faxiunum 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 Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
anti 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 arc 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.
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 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 statedd e 14- true. q
Permit No XDv14 Date Z J� 1 1 Read, Sworn to and Subscribed before me.
Disapproved ...
(Signed)
Date
9y'7 — P2. 1
to me well known,
Notary Public, State of Florida
uilding Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
\Icrr,ber 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 fmm
the I'I.innir,;; Board.
A rc- inspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
MIAMI SHORES VILLAGE, FLORIDA
DATE
Work to be rform under t 's Perm
•
N9 2907..;
INSPECTOR
Contractor's
License No.
Amt. of
Permit
Signed• B
194..,
Building
This permit is gra r d to the contractor or' builder named above to `construct the building or to install the equipment or device described in the
application herefor in s ict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance
with any plans, drawings, statements o; specifrcations that may have been submitted to and approved by the proper municipal authorities. This Permit may
be revoked at any time i1f 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 ab of a ass es the res onsibility" for a thorough knowledge of
the ordinances ar;ld regu ations pertaining to the work covered hereby whether shown on the 1 pl o : ; the statiiite n o specifications and •
that he assumes responsibility for work done by his agents, servants or employees. i '',"'"{•'
In consideration of the issuance to me of this permit I agree to perform the work r'.vered hereunder in Compliance 'Nil all ordinances and regula-
tions pertaining thereto and in strict conformity with the plans drawings, statements a specifications submitted to the proper authorities of Miami Shores
Village. In accepting this pertnitl:assume responsibility for all work done by either myself, ..i34.17 agent, servant or employee.