149184-AFYO-Ut.■••1 1 %.)
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Application is hereby made for the approyal of the detailed statement 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 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.
Owner's Name and Address B AR R., No. // ° Street.A E° a .
Registered illaWhitCet=ar&OF Engineer C 0 e ••• /
Name and address of licensed contractor J4 AI L. 1-7/4111 / re. /A/ C _ 36?0(;) >er (-4.4 2 2L1VC
Location and legal description of lot to be built on:
Lot • Block_ Subdivision
Street and Number where work is to be done / 3 C /1/ E. a 4
Sate-work to be done and purpose of building (by floors) //vS /A L L 3 () re) /v 4-4 eci
) 3 4/2 4. p ciic7
64-- /cos-rev
LS 77 "te" 6 tof,"
and for no other purpose.
New Building_ Remodeling Addition Repairs No. of Stories
To be constructed of )( / 7. Kind of foundation_ E Roof Covering 4.---)( S7
Estimated Total cost of improvements $_ 3 3 s Amount of Permit $
Zone cubage required___________________________ __Plan Cubage
Distance to next nearest building. __Size of Building ......
Maximum live load to be home 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
be sent . /Z.4 1 " / 7- 04/,.4 "/Ke g? O 0 ze
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 Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida, 'ennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- n • actors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the ch ublic notice
or notices as are required by the Act The undersigned agrees to employ only such subcontractors o this
permit, as are licensed by Miami Shores Village.
Remarks (Si
STATE OF FLORIDA, I
COUNTY OF DADE. I ss *
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally p-
peared
Disapproved _
( Signed) ____ •
Buil
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 sta strqtrier 2—
Permit o. Date Read, Sworn to and Subscribed before me.
ate--
nspector
PLAN NG BOARD_
Chairman
Member
Member
Council Approved
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re-inspection fee of $1.00 will 4 . 0 charged
materials and/or workmanship.
IAM I SHORES VOLLASE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING
ERMIT
Date .1.2 0 C
to me well known,
Notary Public, State of Florida
My ommission Expires
-DATE
Member
Member -
Member__.____
_Date Disapproved
making corrections or changes to this application after approval
when such re-inspection is made necessary by improper notice
Date
has been obtained from
for inspection or faulty
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