DRIVEWAYd
Application is hereby made for the approyal of the detailed statement or the plans and specifications herewith submitted for the build •
in 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 erein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor Oa/ ..(.1Z. " <
Location and legal description of lot to be built on:
Lot . Block j� Subdivision ..____
Street and Number where work is to be done 1 �J j rZ
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State work to be done and purpose of building (by floors) /Tv�:_.._.._._
Permit No
Disapproved
(Signed)
C in Date 91 / 1 '
BUILDING INSPECTION DEPARTMENT t `
APPLICATION FOR BUILDING PERMIT a
MIAMI SHORES VILLAGE
`I€�rAl �rvbv
Chair:rran
Member
Member.. ... _..-- •-- ....._..._. _ ...._.....
Council Approved Date
j ° t 2 � 2 _ Nc._1..� 1._... Street.— �
Date..._l.. .
geared
PLANNING BOARD DATE
}c3a Is 3c7,
„e2
,.1 nl'•.nt• Lntnnttnt t .11
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 $ 504 Amount of Permit & 1 /1 1
Zone cubage required Plan Cubage
Distance .to next nearest building.. Size of Building Lot
Maxunum 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 perrnit does hereby certify that he understands and accepts his obligations as an employer
lenient,
tors or sub - contractors mplo> c • . y him
site of the work s h puhli notice
ork to be perfo ed un•er this
of labor under the Florida N‘'orkruen's Compensation Act, being Section 5966, Compiled General Laws of Florida, I'erma
and has complied with the provisions thereof, and will require similar complianc
in the work to be performed under this permit; and will post or cause to b
or notices as arc required by the Act. The undersigned agrees to employ only
pennit, 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-
f�O_ ...._._ Read, Sworn to and Subscribed before me.
; Date _
Notary Public, State of Florida
Building Inspector My Commiuion 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 by him stated are true
Member _ ...
......._..._
Member
Member .... _.._ . ..._ _..- ...
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 PLtnnir.g Board.
A re•irr.pection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection ere faulty
materials anti /or workmanship.
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THESE PLANS ARE APPROVED FOR ISSUANCE OF A BUILDING PERMIT
❑ WITH NO VA..RI1NCPS ❑ MTH VARIANCE(S) LISTED IN "REMARKS"
NO OTHER DEVIATIO' S FROM T`{E MI ^,MI SHORES BUILDING AND ZONING
ORDINANCES WILL BE PERM!T7O 1.171V.E:' SPECIFICALLY LISTED BELOW.
ALL OTHER APP' ICAB'.E ST AND COUNTY LAWS MUST BE COMPLIED
WITH BY ALL PARTIES.
FIRE DEPARTMENT
PUBLIC WORKS
POLICE DEPARTMENT
BUILDING DIRECTOR
PLANNING & ZONI;iG BO :,'.D
VILLAGE COUNCIL
PRELIMINARY: FINAL'
REMARKS:
Aut` Stnature Date
APPROVAL
COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED
BY MIAMI SHORES VILLAGE IS REQUIRED. THE ARCHITECT, BUILDER 8
SUB CONTRACTORS SPECIFICALLY L
ING REGULATIONS WHETHER OR NOT INDICATED HEREICL
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