Sink Well 196102
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the appprotal of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. Tiris 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. _
A /
-.-............
Date ---".'�....-- ....-'--'--'----------_..-
... 19 ...
Owner's Name and Address..�..4../..1._f1-.�'�_'f.'_'_L.. -------....- .. -. - No ................_.___ Street_-______..._
Registered Architect and/or Engineer__..
Name and address of licensed contractor
Location and legal description of lot to be
Lot......... ........ .---_------------_--- Block ---------------- ---------------
Street and Number where work is to be done...X___2_
State work to be done and purpose of building (by flo
II
for no other purpose.
New Building ----------- ................... Remodeling .- ___ --- --------- Addition ------- ------------------ Repairs ............... ----- ---- No. of Stories ---- ---_......----
---"
To be constructed of_ .......................... Kind of foundation__.---.—'--.._. .................... ................. _. Roof Covering ........................ .-------- --_-__—.-
Estimated Total cost of improvements $..-_._..------ ----------------- __—.__Amount of Permit $.....�'e.. ':�'v..............___..._.....
'-------------------------
Zone cubage required ----- ------- ------- ---------------- ---------------- ---------.--Plan Cubage_-_-
Distanee to next nearest building.._..... ------------------------ _._.__.___Size of Building
Maximum live load to be bome by each floor .._— -------------------_...
I hereby submit all the plans and specifications for said building. —AB notices with reference to the building and its construction may
besent to-_._'-------------------.._._------_------- .------ --- —--- ---------------------
The undersigned appbcant 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 5966, 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 tinder this permit; and will post or cause to be posted for inspection on the site of the work such public notice
in notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be perforn�e under this
permit, as are licensed by Miami Shores Village. - /l
(Signed)-----�/it---
STATE OF FLORIDA, I COUNTY OF DADE. ss
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 lie has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are
true. /
Permit No._ Z .. _ 927_ �___._..__..--- Date....=p./___. Read, Sworn to and Subscribed before me.
Disapproved___._ ............._. Date._ ___-- ---------- _----- ----------------- _._..__.............._.........._...._..._....__.._-. --_------..__—__.__.._
No
Public, State of Florida
( Signed) ----- - - - - ----- - ---------- -- Y Bud rg Inspector My Commission Expires ------- _---------- ............ --------------
PLANNING BOARD__._-__.__ _.._---------- DATE
Chairman ._._.._.._._..........._._._..-.---_-._.._.__.._'-.---___--__.-_ Member ......
Member------------ -... ............ ----'--`--------------- ----'--- Member .._
Member_ ..... ............. _.__.._.-_--------- .._._.-_^__—_.______— Member .....
Council Approved ._...__-__.__._.----------- ._._..___---_----------------- _---- Date Disapproved
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.