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1976 - MECHANICALMIAMI SHORES VILLAGE BUILDING INSPECTION DEPA43TMEfIT 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 with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during pregress of the work. Date ..._. .._._.__......._.._.�._..._�_., Owner's Name and Address .......n �a'd .... No..��.,f.�....... Street_... _.... � Registered Architect and /or Engipcer Name and address of licensed contractor ./ ..... . , Location and legal description of lot to be built on: Lot Block S bdivision Street and Number where work is to be done .244 State work to be done and purpose of building (by floors) and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation goof Covering Estimated Total cost of improvements $. .gt?.P . 0 Amount of Permit ® 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 The undersigned applicant for this building permit does hereby certify that of labor under the 'Florida Workmen's Compensation Act, being Section 5966 and has complied with the provisions thereof, and will require similar compli in the work to be performed under this permit; and will post or cause to be . or notices as are required by the Act. The undersigned agrees to employ o pennit, as are licensed by Miami Shores Village. Remarks Disapproved (Signed) 1 Dat'_ Building Inspec'for /PLANNING BOARD 1 -- o :,,.... ..11,.1211-- 4 reference .DATE to the building and be sent to Notary Public, State of Florida My Commission Expires 2 its construction may g nce oste su n.'erstan s an . omp' ed Ce eral La fr.m all ntrac or ins ctio 1 3 ... � on e e r 0 Pe rm f. ©6z. ccepts his obligations as an employer s of F Permanent Sup nt, r s. tza a s em . ,..' hint th_' ork s is notice _ un this,. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, dulythorized to administer oaths and take acknowledgments, personally ap- peared to me well known, 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 .._._'� �J Date / ? Read, Sworn to and Subscribed before me. Chairman Member Member Member Member ...... _ .._.___ ..._ . .._._ ._ - -_ Member Council Approved Date Disapproved 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 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.