534 NE 102 St (8)Y
Owners Name and Address ..T ... \.✓l �"tS..
Registered Architect and /or Engineer
Name and address of licensed contractor
MIAMI SHORES VILLAGE ?`S/-,2 Vo,6
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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. PP
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Location and legal des ription ription of lot to be b
Lot g 4 ``' ' Z 7 Block Subdivision -s
Street and Number where work is to be done
r
State work to be done and purpose of building (by fl rs ) _ . 1\e / A ()CI .. ! � �� N'�? ._.. d^�--
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Pt- �o .4 �1 F e^ d c qe e,) siM l� �p. ss..
and for no other purpose.
New Building Remodeling Y Addition Repairs No. of Stories 1
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $.
Zone cubage required plan Cubage
Distance to next nearest building.. Size of Building Lot
Maxirnum 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 si of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such . ■ tract° s,..on ork o be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)_
4�[iI.1 4
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 _..
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 true.
Permit No.._..___i g c Date S1 fs 7 Read, Sworn to and Subscribed before me.
Disapproved 6 .
(Signed)
Notary Public, State of Florida
ing Inspe My Commission Expires _.
LANNINC BOARD _.._ 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 nfter approval has been obtained from
the Planning Board.
A re- 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.
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MIAMI SHORES VILLAGE, FLORIDA
DIMING Q
LECTRICAL ❑ DATE 195
t.UMBING ❑ PERMIT N° 8485 4 8 5 Contractors p.
�OFING ❑ License No. ``
caner of
gilding
chitect
jntractor
Builder
, gal
scription
'dress of
!ilding
❑ Work to be performed under this Permit '' X
Lot
CONTRACTOR OR BUILDER
Bl.
Signed •
Subdi-
vision
Sq. Ft
Value of
Project $
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
refor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
=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
:nted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
- mining 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.
BY
1'v
Amt. of
Permit $
• BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances 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.
AUTHORITY
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