7876BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N. 7876
Vow t •v
DA
Work to be performed under thfs Permit
Lot
LW'
soJ t,.
Subdi-
vision
Value of '.
Project $
This permit is granted to the contractor or builder named above to construct the building or to install the egatipment
tion herefor in strict compliance with at .ordinances pertaining thereto and with the understanding that the work will be
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal autho
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorisation. A
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specificai
sibility for work done by hi: agents, servants or employees.
t of
ce described in the applica-
ed in compliance with any
is Permit may be revoked
er condition upon which this
knowledge of the ordinances and
i and that he assumes respon-
Signed:
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper truth
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
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.
/ . Date 4,4 L t /�� ,199'
Owner's Name and Address 7-
No Street�'L' '1_i�
Registered Architect and /or Engineer
Name and address of licensed contractor___
194_4 tit 7
973o /VT
Location and legal description of lot to be built on:
Lot Block Sub vision__._ -_ _..
Street and Number where work is to be done .er 9 p
State work t one and pu /rpose of Wing ding (by oors) ___- ____
New Building Remodeling.
To be constructed of Kin o oundat i f Gering
Estimated Total cost of improvements "f ° - 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 5966, Compiled General Laws of Florida, Pennanent Sup lenient,
and has complied with the provisions thereof, and will require similar compliance .. all contractors or b-contractors employed by him
in the work to be performed under this permit; and will post or cause to be post inspection on to of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su +.contract .- s, on .rk to performed under this
permit, as are licensed by Miami Shores Village.
Remarks___ (Signed)
t
and for no other purpose.
Addition Repairs No. of Stories
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
therein by him_ stated are are true.
fi
Permit No. ( �°____ Date___ — iC
Disapproved
( Signed)
of the above escribed construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
Chainnan _.
Member
Member
Council Approved_ Date
NNING BOARD
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
DATE
Member
Member
Member
Disapproved
Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty