53 NE 102 St (6)BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
DATE F lU ? 5
PERMIT N? 8821
Wgik O he performed
71
t .A +k EcH
Legal Lot Bl.
Description
Address of
Building
This permit is granted to the contractor or builder named above to co
12_ c
cation herefor in strict compliance with all ordinances pertaining thereto and dvith the understanding that the work will be performed in compliant with any
plans, drawings, statements or specifications that may have been submitted to and approved 0y the proper municipal authorities. This Permit may be revoked
at any if p p
ns are cha w[
sumes th
time • the work is not done in compliance with such ordinances or if the 1
permit is granted is the understanding that the contractor or builder named above
regulations pertaining to the work covered hereby whether shown on the plans or
sibility for work done by his agents, servants or employees.
under this Permit
S r)(k(Ls
Subdi-
vision
Value of
Project
truct the building or to install the equi ment or device describeCt • the appli-
SignM "
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance
'- g thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper
ag this pergrit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY
Amt. of
Permit
19
Contractor's
License No.
ed thout authorization. A further condition upon which this
sibility for a thorough knowledge of the ordinances and
e st$e cents o specifications and that he �ssur
INSPECTOR
with ail' ordinances a regulations
authorities of Miami Sores Village.
AUTHORITY
s respon-
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 Shotes 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.
-----f ° Date ' � ___ . __ , 19
y
No Street �a �� G��
....._ J k 1-) L'E,___,. J
Owner's Name and Address
Registered Architect and /or Engineer
Zone cubage required
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot_______ Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Subdivision
Chairman
Member
Addition �►'�'�° Repairs
New Building Remodeling
To be constructed of Kind o oundation
Estimated Total cost of improvements $ Cs Amount of Permit $
Flan 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 b performed under this
permit, as are licensed by Miami Shores Village. ��
Remarks (Signed __
No. of Stories
Roof vering
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, bein • by first duly sworn, upo oath deposes and ays that he is the
of the above s • rib =i construction, that he as carefully read pie foregoing application, and that he did sign the same, and that all facts
therein by him .t.ted a true.
Permit No ,.1 Da SP.1 Read, Sworn to and Subscribed before me.
Disapproved( ____ Date
Notary Public, State of Florida
(Sig ed
Buildin nspector My Commission Expires
PLANNING BOARD 1 DATE
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.
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