FENCE PERMITBUILDING 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 progress of the work.
Location and legal escription of lot to be built on: � �
Lot__...4?f_..l Block 1. Subdivision._._�r
Street and Number where work is to be done /1/1 17 C.
State work to be done and purpose of building (by floors)
.2,2 7 '
To be constructed of Kind of foundation
STATE OF FLORIDA,
COUNTY OF DADE. J s
Permit No. ___�L
Disapproved
(Signed)
:, '._ Date
Building" Inspector
MIAMI SHORES VILLAGE
Chairman
Member
Member Member
Date
No J./_I 1 street . __r�.... ` �. /
Owner's Name and Address ..... ...._ .
Registered Architect and /or Engineer _.
Name and address of licensed contractor 6ha'<-4L f .( eel < .L
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
:ate
Roof vering
Estimated Total cost of improvements $ Amount of Permit $ a
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 the plans and specifications for said building. All notices with reference to the building and its
be sent to
ate ` �" k:_G Read, §wom to and Subscribed before me.
Notary Public, State of Florida
PLA I /NC BOARD DATE
construction may
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 rovisions 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 � ► ontractors, on yr�fk to be er med , ujsder is
permit, as are licensed by Miami Shores Village.
Remarks (Signed )
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires
Member
Member
Council Approved Date Disapproved Date
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.
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IP
APPLICATION FOR BUILDING PERMIT
A.pplicaticn 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 progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer _.
Name and address of licensed contractor
Location and legal escription of lot to be built
Lot____)___ Block !
Street and Number where work is to be done_
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No._- - -? '>
SS.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
4 1/lue) ..
on:
Subdivision_.._Z
e`iit
Date
Date
PLANNING BOARD DATE
No J.j /L Street
Remodeling Addition Repairs
ate �` � (fr Read, Sworn to and Subscribed before me.
��,,��tt
�.%, /am,
State work to be done and purpose of building (by floors)
e2.2 2 ' � � 1Lz
and for no other purpose.
No. of Stories
New Building
To be constructed of Kind of foundation Roof °vexing
Estimated Total cost of improvements $ Amount of Permit $ a �� k
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 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 ontractors, on yr�Ik to be med , u)der g is
permit, as are licensed by Miami Shores Village.
Remarks (Signed).
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Disapproved
/' z Notary Public, State of Florida
( Signed)
Building Inspector My Commission Expires
Chainnan / .. Member
Member Member
Member Member
Council Approved Date Disapproved Date
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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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A/1g 9/
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