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Owner's Name and Address _________
MIAMI SH LURES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
Registered Architect and /or En
Name and address of licensed contractor .0—
Location and le al / desc 'pti of lot to b ilt
Lot / 7/ W 'he id Block _ Subdivisioon__
Street and Number where work is to be done ! __ 1_Y '
State work to be done and purpose of building (by floors)____.Q'u';•
New Building £ Q` Remodeling A
To be constructed of C !_! - Kind of foundation
d
Estimated Total cost of improvements $ ���' c�'d • Amount of Permit $_____ �- •..,. _
Zone cubage required_ - ________ Cubage_ _
Distance to next nearest building YQ 'p! ______________— ___Size of Building Lot 74 f Yo
Maximu live load to be borne by each floor
I hereby submit all e , lans a}� spe if �: tions for said b ilding, All notices with reference to the building and its construction may
be sent to _ l
and for no other purpose.
tion Repairs No. of Stories
• _e_
The undersign .plicant for II s buiTmg 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 speedo
or notices as are required by the Act. The undersigned agrees to employ only suc oaf' onirac
permit, as are licensed by Miami Shores Village.
Remarks ( Signed
STATE OF FLORIDA, 1
COUNTY OF DADE. j
ss.
Before me, the undersigned authority, a notary public, duly authorize o administer oaths and take acknowledgments, personally ap-
peared
------------------------ - - - - -- and who, being by me first duly sworn, u on oath deposes ands that he is the
of the above described construction, that �ias yarefully read ttthhhe foregoing application, and that he did sign the same, and that all facts
therein by him stat . are rue. V -
Permit No. \ Dat __25' s __ d, Sworn to and Subscribed before me.
�l 1
Disapproved , ,__ ____ Date
(Signed) ,r� � � r
Buildin Inspector,
Date MAR 2 1 952
!f(h
No 37t2 Street g•_4 • /G
mar ccCs- *^
is .. 'g + tions as an employer
lo ':a, P•rmanent Supplement,
tors employed by him
work such public notice
be performed under this
to me well known,
Notary Public, State of Florida
My Conunission Expires
�1JANN1N BOARD DATE
Chairpan Member
Membc 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:
t5 A::ey
;
NNlcsIson
AUGU. T DC WaKil'L4h
coal. ENGU. k
M'
t d m►AM F:.oiiipw
14..t:. a4.:T* _ST
ENGINEERS CERTIFICATE: I hey certify
that the Survey of the property described
hereon is true anc correct to the best
or my khowiecge 3na oelief as recency
s ure 4 u;"1% a;y t trection rhl that there
fr no .croachni "irsAn i Hj0u t1 noted.
Reg. Ski , .or No. 66. State or Boring. • .
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