464 NE 92 StBUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT r
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
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 regula-
tions 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 S.e amp —1
Registered Architect and /or Engineer
Chairman
Member
Member
Council Appro
STATE OF FLORIDA,
COUNTY OF DADE.
Building Inspector
MIAMI SHORES VILLAGE
Maximum live load to be borne by each floor
Permit No.__ >�J?L�— — __ Date 1/4,;". 7 1
Disapproved Date
(Signed)
to / ailministet
mber
Member
Date Disapproved
Date_
street 61 t
77 ' r
Name and ad s of licensed contractors` /L%L1�C✓ 142____1
Location and $a description of lot to be built on:
Lot / , _ Block —_ __ Subdivision . ...: _—
Street and Number where work is to be done '1/ ii. � ,g L-- 42-*
Z
State work to be done and purpose of building (by floors) ��'''_�� _,
-----4.?-C' f ' _�.._� /°'t / e e-r [ le
__and for no other putgose.
Repairs No. of Stories_
Covering -- No.
/ �-_- _-- _ —__ ---
New Building ° — ___�___ Remodeling __ Addition_
To be constructed of_LiJ__ Kind of foundation____ ei.4 .ys Roof
Estimated Total cost of improvements $L 6,_ ' _‘_; c— __— ___Amount of Permit $ /.0
` — j
Zone cubage required die) c, , _Plan Cubage .. / al�5.2� �`��� __
Distance to next nearest building L Size of Building Lot —__/ +
I hereby submit all the plans and specifications fo; said building. All t gtires with reference to the building and its construction may
K `=.
be sent to fi 1 ' / f-4
The .undersigned applicant for this building permit does hereby certify that be 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 posted for in,spec on on the site of the ork s h public not e
or notices as are required by the Act. The undersigned agrees to employ only such subydntr tors, on work to r od under is
permit, as are licensed by Miami Shores Village. r , ,
Remarks (Signed) �_:"; "`
Before me, the undersigned authority, 'a notary public, duly authorized
appeared \ � J,�t
and who, being by me first duly sworn, upon oath deposes and says that be is,the
of the above described construction, that be has carefully read the foregoing"application, and that he did sign the same, and that all facts
therein by him stated are true.
oaths and take acknowledgments,
Read, Sw to and Subscribed�b,04re nte.
personally
to me well known,
tart' POEN%rySRgarPf : ." ontgs eF Cart*
y cemr6s%bn exp es J anuary 15,
,� 1950
My Cothiissioa
P. N NG BOARD 7-7 DATE
Member
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.
1.
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