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BUILDING PERMITO er's Name and Address.. ' �; °��� ' t Registered Architect and /or Engineer Nam and address of licensed contractor .__ 4 Lcxcation and legal description of lot to be bup' n: Lug Block // 56scet and Number where work is to be done State work to be done and purpose of buu'lding (by floors) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval 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 Slides 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 pIsIs and specifications must be kept at building during progress of the work. � Date.. - . � , 19 Street and for no other purpose. I , iuilding Remodeling Addition Repairs No. of Stories To 'ea, constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $.__=(.61 Amount of Permit $ FAnte cubage required .Plan Cubage DI , stance 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 5968, Compiled General Laws of Florida, Permanent 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 � cr notices as are required by the Act. The undersigned agrees to employ only such sntractors, on work to be performed under this permit, as are licensed by Miami Shores Village. - Remarks..._ (Signed ). STATE OF FLORIDA, COUNTY OF DADE. Ise. Chairman Mor:ber Member _. Council Approved Date NOTE: A charge of $1.00 will be made for making the Planning Board. A re- inspection fee of 31.00 will be charged materials and /or workmanship. Subdivision , PLANNING BOARD DATE 9 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. Pe2rrit No..._ r �� . �M -___ Date / Read, Sworn to and Subscribed before me. Disapproved -� D e, Notary Public, State of Florida (Si m) y v; a � _ / / 4 Building Insp Ctor My Commission Expires Member Member Member Disapproved Date corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty MIAMI SHORES VILLAGE LIILDING INSPECTION DEPART 'E 'T APPLMATION FOR BUILDING PERMIT Owner's Name and Address._._ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buiL- 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. 'Registered Architect and /or Engi Name and address of licensed contractor Date ��[ ,19__tg Location and legal description of lot to be built on: Lot__ Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs !/ No. of Stories To be constructed of Kind of foundation �_ Roof Cowering-- Estimated Total cost of improvements $____7-9 0 Amount of Permit $ 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 5966, Compiled General Laws of Florida, Permanent 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 po . inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ o such subc• tractors, on rk to be performed under 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 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 sVted are true./ Permit No.__________. Disapproved _ ( Signed) Chairman Member --7 -- -- Date F . Building Inspecto Date to me well known, ead, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires__ PINING BOARD_. __ _ DATE Member 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 Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Lot_ STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SH e RES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval 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. Date ,19 Owner's Name and Address No Street Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors) and for no other purpose. New Building _ Remodeling Addition Repairs No. of Stories To be constructed of______ Kind of foundation _ _ 1oof Covering Estimated Total cost of improvements $ Amount of Permit $ Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor_ 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 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the nrovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this perniit; 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks - (Signed) 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 -ate true. Permit No _ - _ Date ' % Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida ( Signed) - -- — — -- - Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member 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 Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.