107941„11 a
MIAMI SHORES: VILLAGE
BUILDING INSPECTION D AR MEN`r
APPLICATION FOR BLIILDI G PERMIT
Application is hereby made for the approval of the detailed statement of the plans
d specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and «s is ormity with the Building Ordinance of Miami
Shores Village, Flo da, and all provisions of the Laws of the State of Florida all 1 • • 'S . ces of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village ;shrill be com )
plied with, wh ether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work. /
1
5 0 l
, igS
t
Street— 1 Q
Date
Owner's Name and Address tALS L � 'gl. F5
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on
Lot_ ' Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
r
New Building Remodeling Addition Rep
To be constructed of Sin •, •, . datio Roof Covering
Estimated Total coat of improvements $ a O ‘•• Amount of Permit $
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with ence to the building and its construction ma
be sent to
ds and accepts his obligationg as an employer
The undersiggnqed applicant for this building permit does hereby certify that he
of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled
and 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 posted for
or notices as are required by the Act. The undersigned agrees to employ only such suboon
.permit, as are licensed by Mian Shores Village.
Remarks ; (S IO
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer a
peered
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, an
therein by him stated are true.
Permit No Date
♦-
Disapproved Date__,
(Signed)
Building Inspector
Read, Sworn to and . ubscrfbec before me.
Notary
My Commission
PLANNING BOARD ATE
Chairman' Member
Member Member
Member Member
Council Approved Date Disapproved
NOTE: A ge of $1.00, Will be made for making corrections or changes to this appli
the Planning Bo
lie, State of Florida
Tres
and for nn other purpose.
No. of Stories
nerel Laws of Florida, Permanent Supplement,
ntractors or sub - contractors employed by him
on the site of the work such public notice
on work to be - .. ed under this :!
and take acknowledgment's, personally ap- "!
to me well known,
that he d d sign the same, and that all facts
Tate
on after approval has been obtained from
A re-inspection fee of $L00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials an /or workmanship.