Roof 1982MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the npproyal of the detailed statc,m•nt art 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
Shares 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 comphea with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date ... _... _....
.. _..._._,..._.__...»_.. ,19..�_
s Name and Addr✓% �_gh7
Owner Street Y»_l..IJ....._t_-......_.Q-
Registered Architect and/or Engineer ................... ...................... ........... ..Q��iPi�?y J�A......,„,.. , .,. ,.. ,.,,,,,..............................
Name and address of licensed contrpclor.........�.s% /200F//%� ��?f?„»/Q%d,.L/�A/.�A.,
Location and legal description of lot to be built on:
Lot............................................ Block ..................... Subdivision._..._......_._._ __..__.._.._—. .......... ._.._.._
Street and Number where work is to be done ... ............
State work to be done and purpose of building (by
e-Ai na "7`i--r/0.2A /'m-rrA'.' 7rs ,, Sn
4.. or --and for no other purpose.
New Hui:ding ............................ Remodeling......................... Addition.......................... Repairs.......................... No. of Stories...... .
To be constructed of ......................... Kind of foundation., ............ ......................... .................._. Acof Covering....%
Estimates Total cost of improvements S......... � Qf/ ..-.......-.Amount of Permit 0 ... ___........ _ ..._..._. e'Yy�
Zone cubage required ..... ............................................ _...... .... -------_.Plan Cubage.................... --.__........................�%✓f �.TV.-'7 .....
Distance -to next nearest building ........................................... ......... ...... Size of Building Lot ....... .............. ..... _................ ..... ........... ..._.._...._
.maximum live load to be bonne 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
besent to.. ............................................................................................................................................................................ ............
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as nn employer
of labur under the Florida Workmen's Compensation Act, being Section 5900, Compiled General Laws of Florida, Permanent Supplement,
anti has C0111phed with the provisions thereof, and will require similar compliance from all contractors or sub -contractors employed by him
.n the work to be performed tinder 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. - I
Remarks ... _.................. _............... (Signed) ... -_....
STATE OF FLORIDA, 1
COUNTY OF DADE•. r as.
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, being by me first duly sworn, upon oath deposes and says that he is the.................................................................... . ... ....
of the above described construction, that 11e has carefully read the foregoing application, and that he did sign the cone, and that all facts
therein by himy�statted /afire ttrue.. ++
Permit No..�t_L1 Va.__........... Read, Sworn to and Subscribed before me.
Disapproved..... ......... _....... Dale.._...._.__......._.._..........._. . ...................... .. ._._._...—....._.
» Notary Public, State of Florida
(Signed) ..._.....-.... _:_.........................................._......_......
PLANNING BOARD ...................... .............._........ ._... DATE
Chairmun...... ...................... .......... ................... _._.._................ Member ....... ........... ............ ___ _...... ........ __.__................. .....
.Mernber .- Member ......... ......_..._..._.._»__.___..._..._...._--------...__-.._.._
Member..... .............. _._..._._._......_._.._._.._.._._--._._.._._ Member _.. .............
CouncilApproved........._.................................._.._...........__.....Date Disapproved .............. ._ ..... ................................... .... .............. Date
NU T B: A charge of $1.00 will be npnde for making corrections or changes to this application after apprm•al has horn obtained frain
the I'lannin- Ilwrd.
A rc-inspection fee of $1.00 will be charged when such re -Inspection is trade necessary by improper notice for insptWon or faulty
materials and/or workmanship.