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Disapproved T
(Signed)
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 progress of the work.
Owner's Name and Address__
Registered Architect and /or En r i
New Building v Remodeling A
To be constructed of 4 - Kind of foundation
I hereby submit all
be sent to____
M)AM) SH ERES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FqR BUILDING PERMIT
Name and address of licensed contractor
Location and legal desc 'pti } of lot to b ilt
Lot . ,L c _ __�Q__ Block L
u uvua v a�avu_
Street and Number where work is to be done
work to be done and purpose of building (by floors)____
Date MAR 21 192
ition /��r Repairs No. of Stories
w
• Cw=t �? of C G -
Estimated Total cost of improvements $____ ar. :"*d_______ _________ of Permit $_________ -
Zone cubage required yo_ . - Q_Q__________ flan Cubage ' ! / - &O Z !
-- -- - - -- --
Distance to next nearest building Y ____________ of Building Lot 7.1 x l 1
Maximum live load to be borne by each floor____________
Tans a c spe if'c:tions for said b ding. All notices with reference to the building and its construction may,
The undersign plicant for t s bu : mg permit does hereby certify that he understan .. and accept
of labor under the rida Workmen's Compensation Act, being Section 5966, Compiled eral Law
and has complied h the provisions thereof, and will require similar compliance from contract
in the work to be performed under this permit; and will post or cause to be poste . ' spectio
or notices as are required by the Act. The undersigned agrees to employ only sue .ontrac
permit, as are licensed by Miami Shores Village.
Remarks
BOARD DATE
Chair __ _ , Lf Member
Memb ___ Member _
Member Member -
Council Approved Date Disapproved
and for no other purpose.
tions as an employer
a, Permanent Supplement,
contr tors employed by him -
of t work such public notice
rk . be performed under this
STATE OF FLORIDA,
COUNTY OF DADE. ss•
Before me, the undersigned authority, a notary public, duly authorize o administer oaths and take acknowledgments, personally ap-
peared
to me well• known,
and who, being by me first duly sworn, u on oath deposes and says that he is the
of the above described construction, that as refully read the foregoing application, and that he did sign the same, and that all facts
therein by him stat.d are true.
Permit No. Dat _ d, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
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:
has been obtained from
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SuRVe.Y
LOT 1`T �-1N� : YZ LOI8OC 4
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er ,
MIAM, SHOR's8 1 AMrNaEo
VILLAGE: M 1AM1I SMORaa►,Fl.oRleA
Aoctxd'ng to Hat lac k f'a .Z
PAtitt.3 evda r:vurity, kf
ENGINEERS CERfFICArt: I hereby certify
that the Survey of the properly described
hereon is true and correct to tho best
of my knew/edge and belief as recently
sure- under my direction and that there
ar rof' oroachtn is nle
jj�� „.3ce
Reg. Su s s u,tin r rusted.
r yCr No. � ��°
/ State of F {pride.
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