MECHANICALMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the appro%-al of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. Tlus 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..__.. ....... _______ �...........-_.----------------
Owner's Name and Address --_-_._,.ems. `Q^�~ No.__ __. Street ------------------
Registered Architect and/or Engineer-_____. _.....__�__.. „ . ,„ .. ..--•---....................._......._.
Name and address of licensed contractor ........... ...._.W�_._____ _ _._._.(J�,r__ _._.___._�W_. �t f.._......__....__...___..._.___
Location and legal description of lot to be built on:
Lot.-.----�._.--.-..-•----....-•.. Block._..-..--.-__._______._-_.
Street and Number where work is to be
State work to -be done an purpose of building (by flo
.......... - and for no other purpose.
New Building ------------------------------- Remodeling----------------- -------- Addition -------------------------- Repairs-------------------------- No. of Stories --------------------------
To be constructed of ---------------------------- Kind of foundatfo ..__._—.........................................._ .goo�C eying...__..........
WPM
Estimated Total cost of improvements $____- _ ..- .__Amount of Permit $_.,,._.�.....—._.__..W........__................ .
Zone cubage required -------------------------------------------------------------------------------- Cubage----- -- --- W...
Distance to next nearest building____________________
Maxirnum live load to be bome by each floor
of Building Lot ----
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 rinployer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors 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 subcontractors, on work to performed under this
permit, as are licensed by Miami Shores Village.
(Signed)_' `sr.=_. -- ' J ���•+•�
STATE OF FLORIDA,
COUNTY OF DADE. ss. 4;erl-1 { - -I-
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared------------------------------- _-------- __ ._--—-------- --------------------------------------- ...... _.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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him tate�e.
�_----_ � Read, Sworn to and Subscribed before me.
Permit No.._.._ __. Date ------------------------------------
u ___-------- - ------ -__.
Notary Public, State of Florida
(Signed) ...---•---_--.------- •-- ... -._ ..-...._.°........ .. ................ ........--
ilding Inspector My Commission Expires__________________________
PLANNING BOARD -------------------------------------------------------- DATE
Chairman -------_--_
Member —_--
Member
Council
Member
Member
Member
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 end/or workmanship.