17308MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval 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 p*ggress of the work.
Date.
Owner's Name and Address B� Y _,,,�,�,,,� C (2. . »
R egistered Architect and/or Engineer t2,21••• Re Re 011-11.9114/1 ,,,,, oreemementnammnausannurawag.Nsaassusspsessasseit'amamestssantesanstmarnarrm
Name and address of licensed contrgctor....4. ,..ge/ � Q,fi!„�� e Q ` ,..,
Location and legal description of lot to be built on:
Lot- ..» .. »» _ Block. _ » / Subdivision
Street and Number where work is to be done 113 ® 0 4 IV.t
State work to be done and purpose of building (by floors) Fe) - iteZZ.t'A l-- fl,,l`�__..,_� ®... e g
New Building Remodeling.:
To be constructed of
Estimated Total cost of improvements $.
Zone cubage required . „...._,
Distance to next nearest building
Maximum live load to be borne by each floor
Disapproved C r .. Date
(Signed) _
Building Inspect
Chainnan ._
Member
Member
Council Approved
Kind of foundati
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
// 0/ 7 ____........,19 ._....
A -
Addition .. Repairs ... No. of Stories
on ' .5.fg t/ f _ Roof Covering.. ». ».
... .. .,amount of Permit
» ...._ Cubage...
Size 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
be sent to_
and for no other purpose.
The undersigned applicant for this building pennit 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 under 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.
Remarks (Signed)
STATE OF FLORIDA, I
COUNTY OF DADE. I ss •
Before me, the undersigned authority, a note y public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared ?~
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 forg application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No 6 7 3 Date 2 — 2
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commissioee Expires
PLAiN BOARD DATE
Member
Member
to me well known,
Member
Date Disapproved ...,_ ...._..,_».... » , ,. ».. »...» Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty