ROOFING APPLMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PEI RMIT
Application is hereby made for the approval of the detailed statement of the plans and specifics itions herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity w ith the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of N (iami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herei" n specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
_/ /, y I "
Date__ G — ---------- -- ---- --- ---- ------- ---- - - -,19 5
Owner's Name and Address___ _4 0_!5:Laj -___1X _1!�!� F �r No.L 4L_3
Registered Architect and /or — - - - - - - -- - -- --- - - - - -- - -- - - --
t
Name and address of licensed coritractor____s v %3..F____% �5_ r dJVS ?I?v T��!�__ CG- __-�� /U /v� �. IV G7-
Location and legal description of lot to be built on:
Lot__ Block---- f-- 0----------- - - - - -- 1
Street and Number where work is to be done___________
State work to be done and purpose of building (by floors)
4 - - - - - - -- - - - - -- ---------------------------------
- - ------------------
--- ---- - - - - -- ---- - _- ------- - ----- and for no other purpose.
New Building _ - - - - -_ -L-'- --------------- Remodeling----------- ------ -- - - - - -- Addition -------------------------- Repairs ----------- - ._--- ------ No. of /Stories ------- , /_____---- - - - - --
To be constructed of___C.t ------- ----- Kind of foundation --------------- ------- -- - ----- _'-- ".--- _- _--- '---- - - - - -_ Ro C�v ng___,�i�- k---------- -_ - -_-
Estimated Total cost of improvements y�___�G__________- _________- _Amount of Permit $________ I_.. —_ __ / ___ _
3 `� �. ---- ---------------- - - -- --
Zone cubage required- �7- d - -A - -° ' '*fYy --------- ---_-------Plan Cubage - -. -- - .7-
± -- - - --------
Distance to next nearest building------ _/
g - -------- - - - - -- - - - - -- -Size of Building Lot.--------- -- - - -- ------------------------------------ - - - - --
Maximum live load to be borne by each
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
besent 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 5988, Compiled General La iws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contracto: rs 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 are required by the Act. The undersigned agrees to employ only such ct }s, () rk under is
permit, as are licensed by Miami Shores Village.
Remarks---------------------------------------------------------------- - - - - -- - - ( Signed )_- - - - - --_
STATE OF FLORIDA, ! ss .
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared ----------------------- - - - - -- ____ - -- - - - g - - --------------------------- - - - - -- - -- - -
-------------------------------
- -- -- 1------------ ------------------- ----- - - - - -- - -- - ---- -- - -to me well known,
and who, eing by me first duly swo on oath d oses an d says that he is tLe __ ------------ _- --- — --- .----------------- _— _____________— _______ _
of the ab ve de ribed construction, at he as care y read VrrMcation, and that he: did sign the same, and that all facts
therein b him s at� e t�Permit _ - - - - - Da _ — _ - _ _� and Subscrilbed before me.
Disapprove - - -- -- ------- ------- D - - -- - ---- -- ---- ------------ -------- -- ------ -- --- --- - - - - - -- -------- ---- - - - - - ---
-- - - - -
Notary Public, State of Florida
(Si - - - -- --------- - - - - -- = - -- --- - - - - -- --- - - - - -- --
Buil ing Inspector My Commission Expires ----- --------------------- __ ------ _---- ------ _- ------------- -----
PLANNING BOARD------ - - - - -- _ ----------- ------ DATE
Chaan --------- - - - - -' - -- 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.