PAINTINGAPPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinan es of Miami Shores Village and all
regulations of the Building Division of Miami Shores Village shall be complied with, whet] r herein specified or not. A copy of
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address.........` ,,.'._
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivisio
Street and Number where work is to be done
State wot f kn one an
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
pose of building (by floors)
1
v
atte.__ '
lEL(tPi e... No
and for no other purpose.
New Building 1 Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
AC,
(Signed):
Amount of Permit $.
Plan Cubage
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
be sent to
wo ' to and Subscribed before me.
PLANNING BOARD ' DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
its construction may
the build -
of Miami
rules and
approved
19..
9
The undersigned applicant for this building pennit 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 inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ubcontractors, on w k t erfor d ' de�thi
permit, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being •y me first duly orn, u'.n o deposes and says thatt he is the.
of the above de ibed construe on, that h ha carefully • the foregbin application, and that he did sign the same, and that all facts
therein by him sta d are true. i t1
Permit No/...1:__-,f..
Disapproved ..
(Signed)
otary Public, State of Florida
mission Expires
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after npproval 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.