DRIVEWAY PERMITOwner's Name and Address .14R ,..1)% E LtrA Fes° s A
��+2 C}
Permit No.._..!`!� ` F Date....@)
Disapproved
(Signed)
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement ur 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 Miaml
Shores Village, Florida. and all provisions of tlic Laws of the State of Florida, all ordinances of Miaml 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
fonzig
No...._ i ° _ . Streetl E•
Registered Architect and /or Engineer
J6 Ave.
Name and address of licensed contractor e • PA t// /tJG, a ( NC ,
Location and gall description of lot to be built on: Q/ /
Lot . r . 1� Block fl.... Subdivision. `� .r _..__ p _ e/ xe QO ij p�
_ /
Street and Number where work is to be done (tO N' E ' 91 r r
State work to be done and purpose of building (by floors) E. k 1 ST/ # W t 6 / O 56 v2/ v w
6i) Y r
6 a -, ..... 6 . re /4 ro 20 w //)c
_..__ 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 S O O o • O 0 Amount of Permit S. V i�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 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 5066, Compiled General Laws of Florida, Permanent Supplement,
and has complied ssith 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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remuks (Signed)
STATE OF FLORIDA, E - 8 4 it
COUNTY OF DADE. ". Bcfore me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared _..
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
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 b y hi m stated �� are true..
PLANNING BOARD DATE
Chairman Member
\fernber 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 Plannir.. llo.ud.
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.