FENCE PERMITFor Inspector:
Date
Type Insp'
Permit No. ►
Name C,
Address " (/ &
Compan '&1iv
Phone #
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
Name & ate
0
New : uilding
Remarks_. ....
(Signed)
APPLIr°,- FO
Disapproved .. _ Date
BuiIlling Inspector
PLANNING BOARD
f =z
Subdivision
MIA SHORES VDLLAGE
BI!t:..DING INSPECTION DEPARTMENT
BUIL
Application is hereby made for the approyal of the detailed statement of 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 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.
Owner's Name and Address__ -'-C
Registered Architect and /or Engineer..
Name and address of licensed contractor. 0. €1A_ tP
Location and legal deseri tion of lot to be built on:
Lot._ ,,2__ Block
Date (r- / , 19_. f _/
't':�LZ -g'.. No street /P=20 _ii/Z y.2
P 5 i/ / —/OO
Street and Number where work is to be done
State w.rk to be done nd puj-pose of building (by floors) ,
ONG PERMIT
all
and for no other purpose.
Remodeling Addition Repairs. ................. .... No. of Stories
Size of Building Lot
Notary Public, State of Florida
My Commission Expires
DATE
Chairman Member
Member _______ __ -_ . Member _
Member _ . Member
Council Approved • Date Disapproved
To be constructed of Kind of foundation, ! ` Roof Covering..
11
Estimated Total cost of improvements $__ D 0 . 0__ Amount of Permit $ o
Zone cubage required _ plan Cubage____
Distance to next nearest building___
Maximum live load to be borne by each floor___
I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may
be sent to___
The undersigned applicant for this building permit dots 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 post:. .r inspection on the site . the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only sup D. tractors, on w be perfo d under this
permit, as are licensed by Miami Shores Village. , E
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 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.
Permit No.___ "4 Date_.15l"3 �_ - ___ Read, Sworn to and Subscribed before me.
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has he-n nbtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper not o toot ,n. :n faulty
materials and /or workmanship.
rP n -r
AlVftTf}