1976 - ADDITIONNew Building F�emodeling
To be constructed of.a �. ff Kind of foundation
/�n
Estimated Total cost of improvements $... , J ` - .. S/..GP®
Zone cubage required
Distance to next nearest building
Chairman
Mcrr.bcr
Member
f
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
rArw_.
Owner's Name and Address sass... /
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be b 'It on:
Lot V Block r 11 Q Subdivision i 5 �+-- le!t._ _
Street and Number where work is to be done __� ..._._. -d __
e done and purpose of building .._.._ ._ ��....._ c t __
State work to be (by ..._._.. -y ITLO Cr i,_ .._4 1OA _ ,�,� ____.�
.°1.... ,...._.- 'Xp -►�xl fi ....�.
Building\
Date
Date
Member
Member
Member
Date...__._.........__ - sass._ i 0 sass_ -..19.
. ._ .. _sass_._. .
__ No sass_... Street __.. _ sass_
be sent to. -.. 4 t... -C NtU .., .. mi A • fat-
of + �
labor under the Florida Workmen's Compensation Act, being Section 5966, Compil
and has compli a ti•ith the provisions thereof, and will require similar compliance fr
in the work to , f;erformcd under this permit; and will post or cause to be posted
or notices as ; equired by the Act. The undersigned agrees to employ only suc
permit, as ar ,ensed by Miami Shores Village.
Remarks._ -_ (Signed)
Amount of Permit Si.
_Plan Cubage _._._ 41$
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 ma iff)
Va. c.stci
and for no other purpose.
Addition Repairs No. of Stories
Cet• `° • Roof Coverings
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
1 Laws of Florida, Permanent SuwIement,
acto or sub- ntractors employed by him
site . ' the work such public notice
r t o be performed under this
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
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
spcctor / y Commission Expires
PLA NC BOARD DATE
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._____rQ-_ -2— 3
Disapproved
(Signed)
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 hecn 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.