MECHANICAL PERMITSOwner's Name and Address. -
Registered Architect and /or Engineer
Name and address of licensed contractor
State work to be done and purpose of building (by floors
... /a - 'h.i., . 2 ® /721", Ave
New Building Remodeling. Addition
Disapproved
(Signed) 13 (e
Building Insp - ctor
MIAMI SHORES VILLAGE
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.
BUILDING INSPECTION DEPARTMENT
1g24,4 /9/4
Location and legal description of lot to be built on:
Lot Block Subdivision..
Street and Number where work is to be done 3.to .../'
a'-r 71U ALL -
To be constructed of Kind of foundation Roof 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
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 pennit 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, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all cputractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for in ection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su ntractors, on work to be ,performed under this
permit, .as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. J 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, application,
therein by him'stated are true.
.'.z
Permit No Date
7
_ / J `a Read, Sworn to and Subscribed before me.
Date. _
PLANNING BOARD DATE
Chairman
Member
Member'
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board. -
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Date
1/ a- 12 64AJ No �� -. Street. 9
2-6o 6ul t
and for no other purpose.
Repairs No. of Stories
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
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
4