550 NE 95 StREICitt
toW
Co ct
23
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Application is hereby made for the approval of the detailed statement of the pla
ing or other structure herein described. This application is made in compliance an
Shores Village, Florida, and all provisions of the Laws of the State of lorida, all o
regulations of the Building Division of Miami Shores Village shall be co .lied with,
plans and specifications must be kept at building during progress of the wo
Owner's Name and Address__ __ _7/ 1' ` C r' �?
Rbgistered Architect and /or Engineer
Name and address of licensed contractor C�.�_l"1^ �1_k_L
Location and legal description of lot to be built on:
Lot la r Block _„r Subdivision H 4'4�__S
Street and Number where work is to be done___ _ 4 9 S `t g r
-- - -- --- �ii-''-- ----- --- - - - - --
State work to be done and purpose of building (by floors) __r F ____ ? _ _�___
'1 I WL /F'" — — _ [IL <-+ G_ _- I .fi J4_ /N / _ _ f__-- and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of L -S Kind of foundation e b hoof ring I'd al [ "
n '
Estimated Total 'cost of improvements $___ 0 t2 ® Amount of Permit $ uto
Zone cubage required __________ ________Plan Cubage
Distance to next nearest building Size of Building Lot / I' 0 _L #1
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 Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and why, beine .y1 e first duly sworn, u / po\ oath deposes and says that he is the
of the a :escri ied construction, that he as carefully read the foregoing application, and that he did sign the same, and that all facts
therein stag`,. are true.
Permit
Disappro
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
uildi : Inspector
PLANNING BOARD
specifications herewith submitted for the build -
ormity with the Building Ordinance of Miami
ces of Miami Shores Village and all rules and
,ier herein specified or not. A copy of approved
No
Sworn to and Subscribed before me.
Notary Public, State of Florida
DATE
Street_AV —t
(Signed) 0 '
My Commission Expires
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- inspection 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.