PAINT PERMITApplication is hereby umdc 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, hlorid.t. 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.
Date ..._......... 4 ®3 _ ........ ,19
.
Owner's Name and Address . 0 ........ e g a cJe- _No 0 Street_IVE 92'
Registered Architect and /or Engineer
Name and address of licensed contactor E
Location and legal description of lot to be built on:
Lot Block .... Subdivision......
Street and Number where work is to be done O /"e _.... Y r
State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved
(Signed)
ss.
Date
tr,•
9 i
ORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
12'1 �-
/f/ / / /C/' 4//,b 3 4
3G fir C 9ftt/V Fr L#
t i &? 12uu r--a
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $.2 -.. 0 Amount of Permit $,..I.l.1!B.1fC
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 umlcrsigncd applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of arbor under the "Florida Workmen's Compensation Act, being Section 59(36, Compiled General Laws of Florida, Permanent Supplement,
and has complied st ith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
:n the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subegntractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)......
Notary Public, State of Florida
uilding Inspector My Commission Expires
9-,- Fa r
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well !mown,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No IC19 ®9 Date 1 I? Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
\Icrr,ber Member
Member .. . .. Member
Council Approved Date Disapprov•••'. Date
NOTE: A ch.rrgc of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the PI.rnnir,. I;u.rrd.
A re smpection fee of $1.00 will be charged when such re- inspection is mode necessary by impropar notice for inspection faulty
materials and /or workmanship.