6476MIAMI 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 Addr s
Registered Architect and /or Engineer... - -- ........
Name and address of licensed contractor
Location and legal description of lot to be built on
Lot Block Subdivision
Street and Number where work is to be done ®... t .,
State work to be done and purpose of building (by floors).
I ��_
Date____ �� � _ ._.
,19
No 4241- . -... Street.,/14E.,,-
__..__.____._.� . -- _._---•---. :..--------- .- ..... and for no other purpose.
New Building_._.. Remodeling Addition Repairs -- No. of Stories
To be constructed of Kind of foundation-... Roof Covering.__a— ®.... :.e
Estimated Total cost of improvements $ is 4 . ° ----- Amount of Permit $ �' e-�
Zone cubage required_._.._____..__ _ _. _. -_ _ _flan Cubage
Distance to next nearest building .
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 performed under this
permit, as are licensed by Miami Shores Village.
Remarks - -- __ _ __------------------ - - - - -- _._.
_Size of Building Lot
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. I 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. e /
Permit No. 6 . & V 1L Read, Sworn to and Subscribed before me.
____..___ - -,- Date._._. Z'.:� ._._.
Disapproved ___.
( Signed) -
..... -.. -- Date-- ------.
Notary Public, State of Florida
g Inspector My Commission Expires
PLANNING 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 after approval has been obtained from
the Planning Board.
A re- inspection fee of $LOO will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
BUILDING 0
ELECTRICAL ❑'
PLUMBING
ROOFING
MIAMI
Work to be performed under
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Subdi-
vision
Address of
Building
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 ..
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. Th
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough know
pertaining to the work covered hereby whether shown on the plans or drawings or in the st• =ments or specifixti• • s and
done by his agents, servants or employees.
i. .
aiuon u':
of the ordinances and "r
a h responsibtlii
zpptfcauon
ith any plans
yoked at any
permit is
ations
rock,
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered
pertaining thereto and m strict conformity with the plans, drawings, statements or specifications su
cepting this permit I assume responsibility for all work done by either, myself, my agent, servan
CONTRACTOR OR BUILDER
under in compliance with all ordinan• • d regulations
• to the proper authorities of Miami Shores ge. In ac•
employee.