1973 GARAGE CONVERSIONSHU E6 V -LAU E
3U LDORIG oNIS ECTION DEPARTME NT
A PLOCATOON FDA-? 32U- OL
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the b:ai
inc or other structure herein described. This application is made in compliance and conformity with the Building rdinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all males and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of apps; ved
plans and specifications must be kept at building during preigress of the work.
Owner's Name and Address -- No.. .. S ^ 57:/;-`24-.:4-11-e2 o f
Registered Architect and /or Engin
Name and address of licensed contractor
Location and lee al dcsri tion of lot to be built on:
Lot.... ` 4; .i Block
Street and Number ere work is to be done
Disapproved Date.
(Signed) v C � G:.
Buir ' g Inspector
ONU P T
Subdivision.//. e? �'.- .t.....LL . -
5�.. ,
State work to be done and purpose of building (by floors) ..._.,
11”,•I.I,..T,..,.T..4 ... .T,,,I,ICM
nod for are o2haz :s �sa
New Building Remodeling Addition Repairs No. of Stories
To be constructed of � —? — hind of foundation Roof Coveaiang -.-
�
.
�
Estimated Total cost of improvements � .... . ...� � Amount of Permit &r�c.'
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 underagncd 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, Pennnne•nt 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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wrar`a to be performed :snc c.r &Is
permit, as are licensed by Miami Shores Village.
_ -.J • � �'�si:.C- e e
Remarks (Signed) �n"�. •/l- -
STATE OF FLORIDA, 4
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 Ins ,
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 fcca3
therein by him stated are true
e ?,
Permit No.._.__ /`� S F� Date....' / 2_- / - -- . dead, Sworn to and Subscribed before ante.
Notary Public, State of Florida
My Commission Expires
1PLAING BOARD _.._ DATE
Chairman Member
Member Member
Member .... _....._._._._ .--- _....._ Member - ----
Council Approved Date Disapproval Date
NOTE: A charge of i1.00 well be made for Making correcdans or changes to this application after tap r •aP, hna trr.go nItaaiae 1 fry n
the Planning Board.
A re- inspection fee of $1.00 will be charged when roach re- inspection is uscio Recesanry by laaapTa; t E31CC far entrp-zzVm c ferAt'
materials anti /or workmanship.
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