500 NE 92 StBUILDING 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 v.iith, 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
Zone cubage required
Disapproved
(Signed)
Council Approved
and who, being by me first duly swor
of the above described construction,
therein by him stated ar true.
MIAMI SHORES VILLAGE
New Building
To be constructed of
Estimated Total cost of improvements
eft
./9 4
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and 1ga1 description of lot to be built on:
Lot Block r.�" Subdivisio
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
�._ Remodeling Addition
Ifts _ _. Kind of foundation
PLANNING BOARD _-
Chairman
Member
Member
Date
No.
and for no other purpose.
Arn?&1nt of Permit $
_Plan Cubage
Size of Building Lot
a'
Repairs No. of Stories
Distance to next nearest building
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 posted for inspect' n„ein the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such, subc9tors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks---- (Sign �.
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
eposes and says t at he is the
fully read the for ing application, and that he did sign the same, and that all facts
Permit No. �' _____._____� Date__ '__ �"" , Sworn to and Subscribed before me.
Notary Public, State of Florida
ommission Expires
Streetij.E
/IL.) /4 ..tk4:
191- '" - 2 _.
to me well known,
Member
Member
Member
Date Disapproved Date
NOTE: A ch: of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Boa
A re- inspect . „' 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.
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