PAINTINGP L1CATDD N FOR R L I LD!NG FERE ErT
Application is hereby made for the approval of the det.iled statemem of the plans and specifications herewith submitted for the build-
ing or o h, -ructure her 1 described This ri licatic is made in compliance and con min ty w.th the Building Ordinance of Mia ii
Shores Village, or da, and all pro isions of the Laws cf the State of F h.rid. all o d nances of K.—RN Shores Village and all rules and
regu a ion. of the Building Div . i of aam Sho, iilage 1 - 1 1 e - ipl.ed with, whether heroin specified or not. A copy of approved
plans and specificati •n must be kei at building durin,, progress of tl.e wcrk.
Owner' Name and Address __._ r c - \ ^ Date 19
IIII/�
�� No. t Street_ __. ,% ,
pearcd _ ._. _
Registered Architect and /or Engineer.
Name nd address of licensed contractor
Location and legal description of lot to be built on:
Lot __ _ Block.._
S'eet and Number where work is to be done.
State work to be done and purpose of building (by floors)
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPAL TMEN
Subdivision
New Building_ Remodeling__
To be constructed of _ Kind of foundation ..
Estimated 7 )tal cost of improvements $__ V, _ Amount cf Permit S.
__.Plan Cubage
_Size of Building Lot
Remarks (Sig -led) -
and for no other purpose.
Addition____ ____ ___ _____ __ _ Repairs.
goof Cov Bring.
No. of Stories
Zone 'ubage required_ __.
Distance to next nearest building__ - _
Maximum hve load to be borne by each floor
hereby submit all the plans 3specuications for said building. All notices with reference to the building and its construction may
be sent to
The unde signed appli ant for th 's budding permit does hereby certify t'lat he understands and accepts his .obligations as an employer
of I bor under he Florida Workmen's Compensation Act being S. `lion 5966 Coi p led Gen al Laws of Florida P r anon S•ipplc Went,
and h s compl ed w ;th he prov':idns thereof, and will require s•milar comp lance from all contractors or sub - contractors emplo .ed by him
in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public noti e
or .otices as are regwr d by the Act. The u. d. r ign •d agrees to employ only such abcontr. 4o15 - err -work to be perforn, d der this
permit as are licensed by M am. Shores \ il': ge.
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ,.nd take acknowledgments, personally op-
to me well known,
and who, being by me first d. ly sworn, pon oath depores and says that he is the
of th abov de c ibed • istruction t, has cirei, illy read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie. - \7 '
Permit No / _? _ 7 ,
Date_�i . A, .__ > ��:_, Read, Sworn to and Subscribed before me.
Disapproved _ .--- -- am.
'4'Q� �, , �. n icy C �? Notary Public State of Florida
(Signed ) - <- -
dgZnspeetor ���� \� My Commission Expires. __._ _____ ___
PLANNING ) 3 t ARD I_ -- -- -- _ -DATE
Chairman 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 'ft'-r approval his been obtained from
the Planr ng Board
A re inspection fee of $1.00 will be charged when such re- inspection is ml. ;e necetsary by improper notice for inspe.•t'or or fa. Ity
materials and /or workmanship.