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MIAMI SHORES VILLAGE ."7-57/-j1;11
BUILDING INSPECTION DEPARTMENT ' te d 2.-"
APPLICATION FOR BUILDING PERMIT
Application is bitchy mode for the approval of the detailed statement ui um plans and specifications herewith submitted for the build
ine or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Fh riit . 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.
. . "�-
Owner's Name and Address .....r
.. � ... ' . : .' ''' tf��`D
Registered Architect and/or Engineer � ! ,,,,. ,.•••,,,., :,,,.,,,...,•.
Name and address of licensed contractor ...... ... ` . .......L....... xL /emu` / t:L......./.7 f 7
Location and lc al description of lot to be built on: 1/ Sale s` — / 0 C'9r 0 Grp
Lot Block Subdivision .. .....
Street and Number where work is to be done _ ]� ,.. . J`
State work to be done and�rpose of building (by floors !- .1d��: � '� ;. 2 � l' G . �'�
r j
.�:.�.:L..� • �• - :r :� i � d for no other purpose.
— Zd
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be sent to.. c
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved
(Signed)
Si.
Building Inspector
Date..._..._.. / ' °.._.. ..._... 19..
No._
r/.a J __
so
k'E �Ii �;
viL..... l „tee
e-Z 6
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation ‘ Roof vering
Estimated Total cost of improvements $ � Ce Amount of Permit S. ..,.., .{
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 a the plans an specific ?s or aid buildin11 notices with reference to the building and its struction may f
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 ‘Vorkinen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Perinxne•nt Supplement,
and has complied s.ith the revisions thereof, and will require similar compliance from all contractors or sub -con actors employed by him
in the work to be performe under this permit; and will post or cause to be posted for inspection dhe site of work such public notice
or noticcs as are required by the Act. The undersigned agrees to employ only such subcontra in w� be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) : .- . � � .... a
c,, rr.:_v? y
Notary Public, State of Florida
My Commission Expires
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 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 tru . 11
Permit No..__. -.. Date ....G�i l46 ......._._._ Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE:
Chairman Mcmbcr °.
Merr.ber 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 hero obtained train
the Planning Board.
A re fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.