ROOFINGZone cubage required
Distance .to next newest building.
and who. being by me
of the above described
therein by him stated
No.. —_ -
Disapproved
(Signed)
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ut ore plans and specifications herewith submitted for the build
ins 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.
.. 19
Owner's lame and Address ' " .1.�" a — .. _._. .Street. -- •_ _ _
J
Street and Number where work is to be done..
State work to be done and purpose of building (by floors): .�O..Z ?"
MIAMI SHORES VILLAGE
Building Inspector
Chairman
Member -
Member .. — .....__..._._..._. — ...._
Council Approved Date
SOTE: A ch.argc of $1.00 will be made for
the Fi.innir, Board. A re rnspection fee of 11.00 will be charged
materials anu /or workmanship.
BUILDING INSPECTION DEPARTMENT
te.
(Sign
My Commission
PLANNING BOARD DATE
MviT , .2l g--23
Expires
Fig y(/0
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
New Building v Remodeling Addition
To be constructed Kind of f undation Y oaf Covering 7/LE
Estimate Total cost of improvements $ ) .......Amount of Permit
_Plan Cubage
_Size of Building Lot
and for no other purpo
Repairs No. of Stories
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 huilding permit does hereby certify that he understands and accepts his obligations as an employer
of Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup ni
ilcent,
and has complied aith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ 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 arc required by the Act. The undersigned agrees to employ only such su• •ntractors, on •rk to performed nder 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 -- -• -- -_ - -
to me well 'mown,
first duly sworn, upon oath deposes and says that he is the. ton
construction, that he has carefully read the foregoing application, and that he did sign the se, and that all facts
true..
Member
Member
Member ...._
Disapproved Date
making corrections or changes to this application nfter approval has been obtained front
when such re- inspection is made necessary by Improper notice for inspection oe faulty