A/COwner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
I hereb
be sent to..
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
.application is hereby wade for the approval of the detailed statement ur ure 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 _ .,r
- �,�1.l1,�� i •J
� Ci
'Kt ! �5 �' l . n r No 9 ...__.. StreetZ 6- - '
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Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done.. Q -
State work to be done and purpose of building (by floors j L L - .``J'
-C
New X4- 1:- jj 4 2
New Building Remodeling Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements $.....
Zone cubage required
c6 l �;
evil -. .e . '_,_ /1 ,
and for no other purpose.
Repairs No. of Stories
!4 Roo Covering
Amount of Permit 5�. ` v
plan Cubage
Distance to next nearest building Size of Building Lot
4
Maximum live load to be borne by each floor
b mit all th .plans d specificatio s for said building. All notices with reference to the _building and its construction may
The umlersigncd applicant for this building permit does hei'eby 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 Sup )lenient,
and has complied sdith 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 ublic notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work rto be performe under this
permit, as are licensed by Miami Shores Village. J� / N b7-'
'
Remarks (Signed)....... ....-�...._.. "`�
Before me, the undersigned authority, a notary public, duly authorized to adnsInister oaths and take acknowled
pealed
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, end that all facts
therein by him stated a true.
Date
Building Inspector
111
Member Member
Member . . Member
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman .. , .. Member
My Commission Expires
to me well known,
Council Approved Date Disapproved ...................Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application niter approval has been obtained from
the Plarinir.g Board.
A rc inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection o' faulty
materials and/or workmanship.