MECHANICAL PERMITS A
e
9-
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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.
f�
Date-- -.� �7 �� .....18•�
Owner's Name and Addre......1&,�-f ... ..._....... ...._.. No...Z-�Z-4 Street_.....'
Registered Architect and/or Engineer......._.... -._ ...._
Name and address of licensed contractor....._C COL `76 _L��� �?/
Location and legal description of lot to be built on: /SG /�G
�-- �y
. Block._._._--_--_...._._____ Subdivision.—.__._._.-.._'e -„
Street and Number where work is to be done-..:.-._----/.X2_3 /"3'P0 5'1—
State to be done and purpose of building by&cors)
IF _
.-and for no other purpose.
New Building_..___.................... Remodelim .
g-----•----------..._._... Addition_..------•--•-•------• Repairs--•----•-------_.._..... No. of Stories._......._......-----
To be constructed of-------------------_.- Kind of foundation_ ._ - --------.._-----__.--------....._._ Roof Covering_......_..__.........-._....
.
Estimated Total cost of improvements$-.__..J2A4 d``s -.--Amount of Permit
Zone tubage 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_---CDL — `� /�G_y.1.1LJ. °_✓_ C �, . �Lv�c _ ���� �✓� -
The undersigned applicant for this budding permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Coi►ipensation Act, being Section 5866,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 (Sed) ef
STATE OF FLORIDA,
COUNTY OF DADE.
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,beixg 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 e. /
Permit No. /a g _._ Date-2_2 a s-L__._ Read,Sworn to and Subscribed before me.
Disapproved _ _ Dat
(Signed) Notary Public,State of Florida
wilding I Pe — — -� My Commission Expires---.._-_ ._
NING BOARD—.-----— —DATE
Chairman —------------- _ -- -- Member
Member ___ ._.._.._ ----- Member _..._._
Member .......... ----- Member ..._.
Council Approved..._•__.__--------_—.----Date Disapproved -_--__..._._._...- .............
.- ---.-._-.----.__.--- -------_-..Date
NOTE: A charge of $1.00 will be mad@ 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.
F