BUILDING PERMITSTATE OF FLORIDA, I
COUNTY OF DADE. Ss.
MIAMI 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 progress of the work.
O
Date - - -G x76/4 , 19
Owner's Name an& Address.... sIZ:ZZ .._G`,� No..__ Street < ?/
Registered Architect and /or Engineer ...0 .i'G9 :c s-S Gam. ~r/ % . ''N�
1
Name and address of licensed contractor.._ _ � � � / - �: :a' d__2 %2 zo ,_,_.' r > l7 l ' ; :;
Location and legal description of lot to be built on:
Lotzc . ' = _i2 __o, _11L . Block ° ' Subdivision._ ° ' C. >_ W-
Street and Number where work is to be done. -. ./Z1I zz CA PO g
State work to be done and purpose of building (by floors) j° <7 /.a,_t:a�a Gam.! > .,_11:'`7.L'.2.,.:,(
%^ y Lf>! /� , e;i_'L � . /? /.� v -4 2w L. IS_ P U d y i� i
Remarks (Signed) ..
and for no other purpose.
New Building Remodeling . Addition Repairs No. of Stories /
To be constructed of__ b_ `l,_ Kind of foundation e
Estimated Total cost of improvements $ /,/L G Amount of Permit $
Zone cubage required Plan Cubage %��
Distance to next nearest building Size of Building Lot A -`
Roof Covering. ?G ='..:
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 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 spection on the site of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such sub ontractors on work yo be performed under this
permit, as are licensed by Miami Shores Village.
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.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
/._ $ /3 = 4 `"
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N a e
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.
Date._ / c 2 , 19
Owner's Name and Address._. ....t4 ° .kte. No. ._ i& , <' Street .92k?
r�
Registered Architect and /or Engineer.?
Name and address of licensed contractor_/ �! ? ._._ >G�°
Location and legal description of lot to be built on:
Lo /- _f .-;`'/ --
Street and Number where work is to be done._Z
Block Subdivision ? <�G7yc!t
State work to be done and purpose of building (by floors) /°
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re-inspection fee of $1.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
, ; Gad c, ,) -
and for no other purpose.
New Building Remodeling ... Addition Repairs No. of Stories
To be constructed of 1 a. , tT, Kind of foundation i_1 . Roof Covering. ?/
Estimated Total cost of improvements $ 4,45'A') '- Amount of Permit $
Zone cubage required Flan Cubage -`
Distance to next nearest building Size of Building Lot._Z 2.'1_'r?s: ' r '
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 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 th work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub�ontractors,jon work to/be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) k
Notary Public, State of Florida
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to adminJster 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 foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
to me well known,
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
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
Owner's Name and Address._.
Registered Architect and /or Engineer
Name and address of licensed contractor
J AMU1 SMO IE VQ [LL
BUILD1ING lRISPECTRON ; ;E A
AFFLDCAT2 pH FOR LADLENHS PE
TMENT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing cr other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shares 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
plan:, and specifications must be kept at building during progress of the work.
Date /
GE
Rir
Il
No..%DO/__Z.2Z Street
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ___.11/ (/! (;
State wo.k to be done and purpose of building (by floors)
and for no other purpose.
New Building Remodeling Addition " Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ G Amount of Permit $
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 / he site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such s} j ct on to 13p2 performed under this
permit. as are licensed by Miami Shores Village. �/ C
Remarks ( Signed) %L %li '� % ✓^
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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 )rue.
Pernsit No V Date
Disapproved _ / Date /_,p__'.
(Signed)+
C:y — i — �_ / Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
,19
My Commission Expires
NNING BOARD DATE
Chairman 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.