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e v y Jo r
Ow ner's Namq an Address '�_
ftesistere 'c iite and/or ifngncef�.,
N-alee and address of licensed contra r
L ocation a nd le " 1 ctio5 of lot td, e ,
I,ot __ : Q
St Be and Nurnber where' v i ork to be d
Stawork t �dou e�an� p s �
C
• !''M
1'cw >3urlding_ Rem
` Q be coristructo vf Y_
x�r r,
E lpphcatio� is hereby inado for the s ifi a 'on h r itte o uil
ap r4iva� of the defarl�d sfatemen�, of the plans and pec .c ti s e, ewith su h� � � the bu d
Ing 9,r Qther- structure.hereiu_ describgdet. Tip application is made in compliance and conformity with the Building Ordinance of :■liaml
Shores Village, l!14rida, anct all provisions of th Laws o the State of Flgfida alt ordinances of ;tiianri Shores' Vil and` all rules and
regulations of a Building Division Of Sores,Yzlfage s be t,onpplied with, whether terein specified or not; 4 copy of approf•edd
1043 and spec f4ationg must be kept - at building dug progress of tne work
E stimated Total 1 st of iinprjefxlent$
Zone Cuba e r aed
g eqir
, -
Disfan e to next nearest b
II-01 ECTI..ON DEPARTMENT
P.P L 1 OA I t f '.Q f
r � r
1l faxvnuni live load to be ! fkor 'e by each Moor - x — - - _ v c
A With
I hereby Submit all the plans and specifleations fft said buddmg Alt notice with reference to the b uilding and" itj bonstwetion iliay,
Tbe
ersi�`nn ap lick t for this bud4#ipg p€ n it . oe ; hereby e€ ti y "th t ie .inderstands and' accepts hi obh'ga #inns a an @inplopes
Qf labor w t e F londa ant f.4 th s ompen atio Att ein S C
59 , mp� eneral aws of Florida, Perma $up leni
ff h. p
and has co mplie d wft -1 tl} pr on s. thereo, a nd w r equwo sm�}lar cam an a from a1I 4Qdtr L tors or Su contractor ty hi
h rh * rls to b peiforme wdei this permit, and wi p Qr dayse to "be loos ell inspe4t' od t$ sit of the r�pclr such ppub 14 o
or notices as ire rg aire b y the Act: The undersigned agree ttt employ only s " u be • • tors; o v �or t p •• r ` in d nude;
army , : ",, •r . _
't as are licensed by f la4 Shores Vil g
iiia�ks . ,r
COUNTY OF DAPF
Before me this undersigned ai thprrtyt'a notary, pubIrF, duly
d who, lie' by ii a st • - �' y swQrA,
o the abo�'e e scnbe b ctrop, that
thereiii hY lun
Permit 1*!.— - - - ,
I,sapo� ed
Signed
Go unell. Approve --
NOTEs A. thaf'ge.of $1.00 will be made ~for, making c
the Planning Board. ,
-A re. inspection fed of l 00 ill bo charged where, sac
aterials and/or workmanship. 4
eposes and says ih be is the_ _ -_ = -_
fully re the fore application, and that
R epairs . N1
`+ Itpof ti eying
n o 9f Pernrik
a rk • Cuba�e_,�
z #' Binding Lo -
1 ' wor`n to sod Stil scri e d befogs trio,
YQtary r11bI10 Stag of FIQrd '
fy C pnirnission expires __,_
__DATE
;�1Qrnber ; - --
«��ember - -- - - `� -- -
take ailciledgm nth persQ4
1.1&mber -__ - - --g -
at Disa.prov'ed — - - -� ate
-.
rectiops or change to this applicatiori_ after approval h as een 41 wined two,
r ' rns is made necessary by nnproper iotce for in s p ection or f aul ty
, � �
_.