WINDOWSMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Apr+lication is hrrvby umde for the ajipiro�-al of the detailed statimicnt 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 Vtllllge, Florida. and all provisions of the Laws of the State of Florida. all ordinances of Miami Shores Village and all rules and
re ruiations of the i3m4ling Division of Miami Shores Village shall be complied with, whether herein specified or not. A ropy of approved
plans and specifications must be kept at building during progress of the work.
f1
Date. .v2 -
Owner's Name and Address .............. � ....� P_1^ __ ........................_.� �.. _... »......... `f 1$.. +
J l � .�.......,..«.. No.. r..�) Street.. ..._...........«. 1.
Registered Architect and/or Ep.gincet ....... ..................... ......... I ............
-... ,...�.,. -
_�
....
1
Name aria address of licensed contractor ...... .»...,»..,............ :.......... _._...._...------ --------------- ......................-
Location and legal description of lot to be built on:
Lot.......................................... . Block ................ .................. Subdivision ...................... ................... _-----.-._—......................................................
Street and Number where work is to be done...._ �2r1�� "' t °.t_.. — ....., �_,. ._... _...... »_._ _v
ello e � exis ��iln, id,rindb-vis ,_ncl instal -,)
State work to be done and purpose of building (by floors ):.:" _.:...» .. .. : ...... :... _�...r ..
ltzri.ir_u ti.ri t�c�. ,�,,rY;;,,�� l�..ciianves�. isi_e (_wron. ._.-
.^',T._i•l.. n_ _ ice._ .-_.._............... .............. .«........«_....... ......... ..... ...w..-.w...«.....«................... ..............__....._
............... ...... ..... .._..... ............ ............................. ........, it 's,_ _....._........ -.................................. _...................
and for no other purpose.
New Building ........... .__........ .- Remodeling.•._' Addition... ....................... Repairs ..................... .... No. of Stories ..... ... ........
....--
To be constructed of ........_.... - . ion........«............................_«...:.. ; «. � Roof Covering-.... .......... ... ................
..:.. Kind of foundation ............. .;
Estimated Total cost of improvements $.....--...----- /\mount 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 buildingk. All notices with reference to the building and its construction may
besent to-. .-........_........:..........:...................'........I------- -..,,........................-....................................
Tare untier•igred applk---nt Fur this building rertnit does hereby certify that he understands and accepts his obligations as an e,uployer
of l.ibur under the Florida WoAmen's Compeasatiou Act, being Section 5066. Compil General Laws of Florida, Perinanent Sup] lcment,
anti has complied tie oh the pIrovisions thereof, and will require similar compliance fro all coat to or sub -contractors employed by him
in tlx �tiork to be prr:orinrd under this pertitit; and will past ar cause to be pasted fir i erti non the site of the work such rublis notice
or notices as are required by the Act- The undersigned agrees to employ only such su era ors, on work to be performed under this
pennit. as are licensed by Miami Shores Village.
Rein.uks................. :....._............_ ». .«.. «.. _. -- — ( Signed )_._...«..
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....... .:....... __._._........»....... :...........------- ......... _._.__._._.......;.:._:._.._............_::.. ......_« .«. w.�_, » .. w...-
.._...... _..... _ _._�.._.._.._._ - _ _.._._ ........__.._.....«.....-........_ _...... » «_ 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 lie has carefully read the foregoing application, and that he did sign the same, snd that all facts
therein by him stated are true.
Permit No..� C d. _. _.. Date..._.__.1..=..�.L___....— Read, Sworn to and Subscribed before me.
Disapprovedate....__... ..... _.._.-...__..._._ ........ .-........... ...__.......- .......... I ....... ._........
Notary Public, State of Florida
(Signed) ------------- ------------------- ....-------------------- -----........
Building Inspector My Commission Expires ....... _.----......�«.....
PLANNING BOARD ...................... ........-------••-----• _...DATE
Chairman--------- -------- - --- _--------------- ---......—_...... Member ....... -....................... ------- ----•--•-_-••--•-----•--•—------- --------------- -
Mcrnbcr....................... _........ - ---....._._» « _._.._... Member -------------------------------------------------- ------------------ ---------_----------•-
,tem1)er . - ---- ---........ -------------- ..........._.-_..—.. _ -— ----- . ----- - Member .... _................ ----------•---•--_----------- -_-----•--•---- — -
CouncilApproved ------------------------------------------------- - ---------------------- Date Disapproved ...... ................-..... ..... ......... ........................._... Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application sifter approval has hrrn obtained from
the P1.1rinit'g Board.
A re-iir,pe(t;on 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.