500 NE 102 St (12)Contractor
Address of work \ p-
Owner
Foundation
Lintel
Final
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Received Ia
Date
Time
BUILDING - INSPECTION
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When readI // a
. 4( PM
Contract'
Address of work 0
Owner
Foundation (
Lintel
Final
Date
Time
BUILDING - INSPECTION
Permit No. 0 4 /
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Received by
kr 4eko
10 (4 •
When ready I AA PM
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building C •
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
PERMIT N? 11873
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
A
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This permit is granted to the contractor or builder named above to co
herefor in strict compliance with all ordinances pertaining thereto and with
drawings, statements or specifications that may have been submitted to and
time if the work is not done in compliance with such ordinances or if th pl
granted is the understanding that the contractor or builder named abo a
pertaining to the work covered hereby whether shown on the vlans or . ra
done by his agents, servants or employees.
In consideration of the issuance to me of this
thereto and in strict conformity with the pla
In accepting this pe I assume responsibility for all
CONTRACTOR OR BUILDER
gap
#» -
Signed
un
proved
s are c
umes t
ings
IN
ermit I agr to perform the work covered hereunder in co a with all ordinances and •ulations
draw _ s, statements or specifications submitted to the . oper autOrities of Miami Shor : Village.
wo •.ne by either, lf, agent, servant or employee.
BY
Subdi-
vision
Value of
Project $
DAT
195
Contra
License ` o
Amt. of 411 ".04
Permit $ ,�� "•
ie building or to it all the equipment or device described in the app
rstanding that th work will be performed in compliance with any p l'dr
by the proper municipal authorities. This Permit may be revoked at ant
raged without authorization. A further condition upon which this permit is
responsibility for a thorough knowledge of the ordinances and regulations
in the statement�r specifications' and that he assumes responsibility for • ork
AUTHORITY
Lion
APPLICATION FOR BUILDING PERMIT
Owner's Name and Address
MIAMI SHORES VILLAGE
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.
Registered Architect and /or Engineer '__/°_ 7
Name and address of licensed contractor___ •//f1(
BUILDING INSPECTION DEPARTMENT
Location and legal description of lot to be built on:
Lot JA 1 2 Block 1 _ ` Subdivision
Street and Number where work is to be done SO
State wprk to be do and p rpose of building (by floors
h ? t_
Ne B uilding Remodeling Addition
To be constructed of
Chairman
Member
Member
Council Approved Date
�J bf 19 � c /
Date /,11!1 ,
_/_t-� S No Street 4 % )
,1
,„ •
2F 4921' f_rLrqe . ` '
� ? and ? foi ` o other 'purpose.
1
Repairs
Kind of foundation__ ____ Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
Notary Public, State of Florida
PLANNING BOARD DATE
No. of Stories
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 .erfornled under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j 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 tru
Permit No 1 a Date Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector My Commission Expires
Member
Member
Member
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:
L