1969 POOLOwner's Name and Address -.
Registered Asehiteet and4of Engineer J _i
Name and address of licensed contractor
Locatio an 1 gal of lot to be built on:
Lot__ P.ii __ Block Z
Street an dri work is to be done
APPLICATION FOR BUIL:! INS P
Application is hereby Made for the approval of the detailed statement of the plans and specifications herewith submitted for the bur..,-
ing or other structure herein described. This application is made in compliance and conformity with the is uildin 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.
State work to be done and purpose of building (by floors)
a
Addition Nv– "Swi —
To be constructed of 'i A l / - K ) K' ou p e , R .
Estimated Total cost of improvements mprovements $ 00' Amount of Permit $
Zone cubage required _Plan Cubage__
Distance to next nearest building a- Size of Building Lot
Maximum live load to be borne by each floor___
I hereby submit all e plans a d specifications for said building. All notices with reference to the building and its construction may
be sent to y ' _eJ .. 79���X . 4 S J .57
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, Pennanent 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 inspec '.n o the site of the wok such public notice
or notices as are required by the Act. The undersigned agrees to employ only suc subcon actor. ..k to be- rformed under this
permit, as are licensed by Miami Shores Village.
Remarks
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
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 1L Date____ . .• a J__ 6 Read, Sworn to and Subscribed before me.
Disapproved __
(Signed)
Chairman
Member
Member -
Council Approved
MIAMI SHORE ILL
WILDING INSPECTION +E `,AR TIC N4
Subdivision__._ --'t'��� __ /lam
J & 9 - - -- .�
PLANNING BOARD.. __
Notary Public, State of Florida
Bc'1.ing n pector My Commission Expires_
_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.
and for no other purpose.
Date
2 , 19..4
No.- If 0 Street_ /4,) Z
to me well known,
DATE
Member
Member
Member
Disapproved
g g g /j 3 , 9
IT
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