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6812BUILDING 0 ELECTRICAL 0 PLUMBING ROOFING: Owner of Building LLAGE, FLORIDA DATE 6812 Work to be performed under this Architect Contractor or Builder VI Legal Description Lot I1 Bl. Subdi- vision Address of $ a Value of I Amount Building Project $ i I Pernilt This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in th Lion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be perforated in .tnpliancet °w_ plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities_ This NrInit may be at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A fur ' n upon which t permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge et the ordiMutont and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes upon -ability for work done by his agents, servants or employees. , Signed- In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper 'authorities at cepting this permit I assume responsibility for ell work done by either, myself, my agent, servant or 'employee. 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 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 Addre3f ° t / S ° / ski i 7''9 Registered Architect and /or Engineer 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 ittin L State work to be done and purpose of building (by floors) No. �e Street , ___" ; Q a: Subdivision and for no other purpose. New Building_ Remodeling_ Addition___ Repairs______:_____ No. of Stories 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___ 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 5968, 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 f the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcon)ra ors, o or, to be erformed under this permit, as are licensed by Miami Shores Village. r r 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 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 Date 5'1 ' % S- Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector PLANNING BOARD Notary Public, State of Florida My Commission Expires 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 $1,,00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.