27315MIAMI 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 building 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 4 9 4 y LJ/1// VERS/ ry
Registered Architect and/or Engineer . f �' / T® (4 c/1 / rec a )
Name and address of licensed contractor WE4 % /ZoL Af4 //i0 Co{?po 782® AM/ 6 5r &1i4 Ni FL. 3,9/44
Location and legal ptdoo of let to be built on:
Lots h /Y 1 B k Subdivision ig ean� /1
a' /Ji O0 wet) 7
a Ree4 pOS .Sc / €AlCS el r�J C444" 00.11 .6 45/4"4.
Street and Number where work is to be done
State work to be done and purpose of building (by floors). state exterior colors (submit samples) /A/ esTA-L L 0A16 ei) 25 re .vs .sf l / r Lf /C
,v /7 tL'/TN eA/L( ) 3 KW FLEc-7 /-164T 4d445 .» a crwo % . ALSS /A,3r4 Tito® (z)
a
7®/ 467 ex/4406T ?4A/$ As peat f SfiEes /RO X4,31 • " , 726.3 and for no other purpose.
New Building X Remodeling Addition Repairs No. of Stories I
d
lb be constructed of CON e, Z� L /'C ®C �? Kind of foundation lee /st/ F. C ost C✓eerE Roof Covering t r x 00 .4 .55$ 1 let C
Estimated Total cost of improvements 6 ,28 ®00 • a o Amount of Permit $ Z q 1 P 4 15 '
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the,r lorida Workmen's
Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, And will require simiirx
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 forinspectioo
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 / ® ®® ®ee'7 sr/4;e /C/ffe 8Z /® (Signed)
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority a notary public, duly authorized to administer oaths and take acknowledgments, personally a eared
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 stated are true.
Permit No.
Disapproved
(Signed)
Council Approved
Building Inspector
Date!
/ s
J'ZI-eVe
Date `r UG y el 3 19 r7
No. /I3 oo Street N, E..2,d 4 v'.
Read, Sworn to and Subsya w ed before me.
me.
› *" of Florida
-
NOTARY PURR 'STATE OF Fi.ORIDA
My Commission Expires my rritlMISS O FO JULY 30,,i9 c.39
PLANNING BOARD DATE 801NDE0 THRU .Gc Hi en. •
Chairman Member
Member Member
Member Member
Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.