830 NE 91 Terr (9); .r,
Chairman
Member
Member
Council Approved_
NOTE: A charge of $1
the Planning Board.
A re- inspection fee of $1
materials and /or workmanship.
MIAMI SF4 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 sub tied for Cne building
or other structure herein described. This application is made in compliance and conformity with the Building Ordinanc Shores,
Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rues and regula-
tions 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.
Date- __ —___ 19 —r.
Owner's Name and Addre /r �� e M,/ "' ° d �FZ No. _1 Street ` 4 4 9 _
Registered Architect and /or Engineer 2E� �A , � gEer
Name and address of licensed contractor '
Location a legal desc tion of lot to built on:
Lot__ `� d /1-) � UZ Block Su division i7eb 7 � 41.
Street and Number where work is to be done
State work to be done and purpose of building (by floors) r / /Aq4
New Building Remodeling Addition
To be constructed of_ __4 c__ Kind of foundation ref_2e •
0
Estimated Total cost of im rovements $_ __ ®��__° _________Amount of Permit $__
1ST O
Zone cubage required ! Plan Cubage T _ f_ o
Distance to next nearest building ___� __ � . Size of Building Lot
Maximum live load to be borne 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 to
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 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, u.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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.__ ___�____ Date
Disapproved ________ ____________ _____ Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member _
Member -
Member
_Date Disapproved
.00 will be made for making corrections or changes to this application after approval has been obtained from
.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
•
Repairs
Roof Covering_
aB
7,5 _
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
r
and for no other purpose.
No. of Stories___
to me well known,
..Date
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