MECHANICALRegistered Architect and/or Engineer
Name and address of licensed contactor
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby uindc for the approval of the detailed statt:,,,t•nt or cne 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 with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during prggreu of the work.
• Owner's Name and Address . ..ttl.Il..t. .s`,?... / e �l _ No. l�'.k ..... Street. ,r� �. t ' •
State work to be done and purpose of building (by floors)
s1J tki
Building Inspector
Date
••C,:t. ,H••∎M•tt MT,UV.t ,tlt..... ttat.
t+ 1// /Q /> / i 3 3 " /
Subdivision ._. g5.,2.:.L. ?. : 14
4 Ai 42
Ncw Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof go-peering
Estimated Total cost of improvements S.. - t.P d Amount of Permit $. 1.75 e l
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 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 Sup dement,
:►tractors or sub - contractors ern
tit) n on the site of the work
on ..work
aria has complied with the provisions thereof, and will require similar compliance from all
in the work to be performed under this permit; and will post or cause to be poste for i
or notices as are required by the Act. The undersigned agrees to employ only s h su
permit, as are licensed by Miami Shores Village.
Remarks ___ ._ _ (Signed
- Xi, .4.?:
�...._ and for no other purpose.
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
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.
� _ � . X .
Permit No. 1 Date / . ........... . ..__ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
ye d by Itim
uhlic notice
-this
to me well known,
PLANNING BOARD DATE
Citair;nan Member
.fcrr,bcr Member
Member Member sass_ __.._sass._
Council Approved Date Disapproved Date
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after eppmval has hero obtained fmtn
the Pl.,nnir.g liu.rrd.
A re 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. t
y Y ; lx ti. •
ett. 1;v snarl:: for ,• ; , tie d to t
`serer: des& t Ls d s r.,:y)) a.tnn is mart
La > toil . 1 ail pr—spoor.! ss of tl,c
kilts% Division of Witt fit. tti Villa a st a
trust be IL IA at building .luring prpgres.
, c Lr/EGGH�L
,x net .vrely: 3 or Engines': /{�
eta''.• ': fe tl 1} ;i' lied Cdr: t;.e Ctor SW790.! -.
- tiptiim lo= ,: be full: on
1?hkk Ju >x:ivi ;ilxs _ _..__
yuck i .., t u. ,{ x,r;
G /.9 /C 14'//# "9-c 71 GoPE.
P tr,..e•Lrig
t Kimi :.f f<rundation.... -.
i AP .1 <, :.f i:n s s'QOD
OT-UDA.
OF DADE. ss
tlie.etn `r>, hirn stated e
Pert., Nci .. _ _..l! �
the undersigned aat'norr
den = . r : s; phcant for this buildwg perin t ioe 1
8 h1,r'; AVc;k,,ien's Compensation Act, br
led w the i( ;tol i therm: and will 1'00,4
etfurn,.d under this permit; and will post
evil red by t'. " A.: The undersigned ai:rees
e Lensed by Miami Shot es Village.
:.y pui,ltc
?SOO
(Sig
MIAMi SHORES VILLAI3Et
Eit�t��`: iG lrlct A DEPARTMENT
Ai 4 "a..tr - )N F' ::! li.LOLDING PERMIT
i y
Y - , '+ e 1, ' t -
t r e r . of the plans and speCifk:booss
't.tr. piianste and conformity *e the Ilittilki
• t t turldi , all ordinances of Missed Shows V
ctmphed with, whether hands ttpamWad or nit. A me,
he work.
Date
P, to i 'hat he understands and accepts his oblip tioatr as
•,r,g S. t. ; :on 5966, Compiled General Laws of Florida, Penmwwat
n i ;r ( t )InpIialce from all contractors or wsb- nx)atrsctors ms
i ;);,t' r,: be posted for inspection on the sift of the work suc
to employ only such subcontxaatg - ts►ynotrk by be part
Read, Sworn to and Subectibed before se.
Notary Public, Staas 1t Florida
Siy Commission Expires._.
Mc'nIher
Member
Me nkw
'Date Disapproved ......._...... __. ._._�
..•ge of Q'. (X't -w i;1 !x ni.tde for making corrections o: changes to this application after apQr'tsrvsl
re .a. 5: X) u,lt be : hargeii w',eli r..''r, revtri isec ;lot; is triad. riecea ary by improper MICOlitlt
:u '. c:•111:,:r.al.tp
�r
and puiTxls•c :,l t:wi.:i,ng (t %+ doors j. - rrySl�Z _ ... � c3 ;Z••. " /i
and for ae other p m
Addition Re,^i — *{+'s. of Stories
Roof Covering
amount of Perm t i - -_ �.. �._. .
Plan Cubage
a fez? mares: `'.luildattg Sane of Building L.ot. -. - -__
be borne by each t1oor
+.y s -ohmic ad the plans lin specifications for said building All notices with reference to the badleLag and its oeOltrticdas May
1. aa. ±hunred to administer oaths and take acknowledgments, paieo aRy ap
._.
— ...to sirs wen keWww,
ito. ;,einYY I.:. .. e. ;...1-Iii de:-.. sworn, atxiii oath deposes .411 says that he is the. ._.:.. — _ _..,....._
th,_ at ",vet des.:nbed corutruc i n, :hat lie has carefully read the foregoing application, and that he did sign t h e same, and that o f 1 -
Duo
has been obtained foam
t0® ins<mttti0p or faulty
is
,' tr.Fi.. ii__,; '., R..4!1...Di PERMIT
v - , t . 1 the pf(en3 and specitiMdo s bere+4ada
t, i t ) pt;p ic'. :I, • - (iii Nu... Me &ad conformity with e �� 'a
i:, c r , • i<rc: i rtv 1 tws , 4 t °,. t' uo∎:?.1, all ordtnmitr a of Mimi Sham V
Eli' f !o .i.e i . `', < .',Ils4 t' :ornq.! •P,1 with, whether laereht tp,ai[hd ar oft. .A. 018,
ns i.c. :: i•' & t t - ,a:iri:rg ;∎ : pr4g;,s.: . ! +'.E wcat'k
w 1 oo 8 it)
, fvsTALI... . L/A p;:. ler.
R-N,D Ci 3 HO C`4 /G. J TI-/ rf/. _515.4. 4 FL? Podr44/# 4
f4 coD .
Trr i:CFi ttt,Oitiiin
,9 n,,e Y
•
7--/. , tia
W c I No 11100411-
Sc R2g a 5 / ��? _ 7..6 D n!. �.c1 26 ST
,:at ,T • a •
1'-
At .-
a tF
9 VILLAGE
t DEPARTMENT
N4 t u P b
Public, Stu
Expires
O� 1716e l0
—
:•t t'iii�: �'Y
Date
Sworn to and Subscribed before tee.
DATE
... awl for ee other papas.
?i a, tt# irter 1... .
.a w i .' , s tweneze tv the bu iritn i sad its coitairvtxiee easy
,r' 41KCeril . .'s9 13si:gx r - -; u as ea retployet '
.iirr. . sw: pi 1F'ir1 k l rwmtaasrnt
;u.-- - •«_____ or latw�.saispet i 411,
44+�raitVin aS - iii ea' No a3ra k
n sctor lrgt ix be ;serf wd wnd*t.
∎ • :: tt r: cwt Kai i r$ tike ec.193corlediputete, poreerdly ap-
to roe well koron.
_ _.._ 1111. .___ ........_..._.....__
pi.c+:.i r;a, an that he did sign ahrae, and cleat 111 ikb
�at;r'rce.rx Uatt
,raps to !his ..r plicsrtkert after app m,al ha +i htrn ebt*keed hcrsa
made tar c: tataty by ;Improper +,•.a t sr lax Lamed on of fealty