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MIAMI 917 ES VILLA ; E
BUIL[ ING `INSPg0TION DEPARTKIt3T
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the dtailed statement of the plans and `sp
ing ' ' or other structure herein described This appIicaticn is made in compliance and conformi
Shores Village, Florida, and 11 provisions of the Laws.of the State of Florida all ordinances
regulations of the Building Division of Miami Shores.Villatfe shalt be complied with, whether
plans and specific ns`niusc L ` =� �'• building during progress of the work.
Owner's Haile aiicd Address__ _.)
Registered Architect and /or Engineer__'
Name and address of licensed contractor
Location and legal description of lot to be built on:
- -- Block_ .. J
Street and Number where work is to be done
State work to be done and purpose of building (b' floors).- ___ q l
New
Estimat Building - i. eniod e lung Addition pairs_.
To be constructed of-_
K �;
on !i
ed Total cost gf improvements $v 1 � 1
inc of foundat _: a
Zone cubage
_
Dista to net nearest wilding _ - - :
_mi_nium live load to be borne by each Moor
e eby submit all the plans and specifications for said building. All notices with referenn
be sent to =- c -
The undersigned applicant for this building"permit does hereby certify that he understands d accepts his oblii"gations as an employer
of labor under tha Florida Wo en's' Compensation Act, being Section 5966, Compiled Cener4l Laws of Florida, Permane Supplement,
and has complied with the p' roisions thereof, and will require similar compliance from all con ctors or sub- contractors em Ioyed by him
in the work to be performed under this permit; and will post or cause to be posted for inspectioi `on the site of the work sue public notice
or notices as are required byy the Act. The undersigned agrees to employ only surly iibcontractoF op wqr- to be performed under this
permit, . as are Licensed by.11iiami Shores Village.
Remarks - = -_'_ _ • -• - -- - - --------- __________________
(Signed)
Amount of Permit $_
_Plan Cubage__ 5 ii
_Size- of Building Lot__
STATE OF FLORIDA,
COUNTY, OF DADL, j s '
Before tile, th undersigned authority, a notary public, duly authorized to administer oaths nd take' acknowledgments, - personally ap-
peared
- . e well known,
and whcl, bein by me" first duly sworn, upon oath deposes and says that he is the__
of the above, escribed construction, that he has carefully red the foregoing application, and th t he did sign tie same, and that all facts
therein by hii* stated are true._
Permit N G o ;� = = -: Date ` v,- Read, Sworn to and Sub scribed before me.
Disapproved _ _r = , - Date - - -- - - -- - - -
inspector
uilding 11fy Commission )xpus__
PLANT i' BOARI) DA E
ificatikis herewith'submitted for the build -
with the BuiIdin Ordinance of Miami
f Miami Shores Village and all rules and
er .ein specified or not. A copy of_approved
No._ -_- _ -___(J Street__
a -s _,,194/
and for no other purpose.
No. of Storie
oof Covering itTj
to the building and its construction may
Notary Publi State of Florida
Chairman. _- Member
Nfember Member -------_---------------
Member ____________ Member
Council Approved ' ` _Date D}sapproved -_______ Date
NOTE: A charge of $1 00 will be made for making corrections or changes to this applhcat on after approval has been obtained from
the Planning Board. \ • s A reinspection fee of $1,00 will be charged when such re - inspection is made necessary b improper notice for inspection or faulty
materials and /or workmanship. , 1 ,