WINDOWSOwner's Name and Address
Registered Architect and /or Engineer
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement us we 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 Mrarn'.
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.
Street and Number where work is to be done........ / ._ R.)
State work to be done and purpose of building (by floors) `-J
G G G
Name and address of licensed contract o
Location and legal description of lot to be built on:
Lot i& tu- Block E Z m S Subdivision
and has complied with the provisions thereof, and will require similar compliance (t'_
in the work to be performed under this permit; and will post or cause posted for
or notices as are required by the Act. The undersigned agrees to em oy only such 1
pcnnit, as are licensed by Miami Shores Village.
Remarks..._ (Signed) i
... ......_._._......_ .. ,1B.� ?y _..
Street-A.L J 5
ic
S Cc.
and for no other purpose.
Ncw Building Remodeling Addition Repair& No. of Stories
To be constructed of Kind of foundation _ Roof Covering .......
Estimated Total cost of improvements $ .Z. ZCL..0 � � Amount of Permit $......d f
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 all the plans and specifications for said building. All notices with
be sent to..
The un:ler.igncd 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, Pen
m all contractors or su . lrtracto
pection on th sit
tra - rs, on wo
su
reference to the building
Notary Public, State of Florida
and
its
construction
may
cnt SohpIleu:ent,
rnployed by him
uch public notice
rmed under this
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
•
t0 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 true..
Permit No..__ Date 1 1i Read, Sworn to and Subscribed before me.
Disapproved ` \ t Date..
'e1 ( �i 4/
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member _ ....... _......... ---
Member Member
Member Member _
Council Approved Date Disapproved Date
NOTE: A charge of $l.00 will be made for making corrections or changes to this application after approval has been obtained from
the I'l.innirg Board.
A rc inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.