FENCEMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION'FOR BUILDING PERMIT
Application k made for the approval of the detailed statement of the plans and specifications
crag or structure herein described. This application is made in compliance and conformity with the - - - - - --
Shores Village, Florida and all provisions of the Laws of the State of Florida an
Division all ordinances of Miami Shores V ,
regulations of the Building Divis of Miami Shores Village shall be complied with, whether herein specified or not.
plans and specifications must be kept at building during progress of the work.
STATE OF FLORIDA.
COUNTY OF DADE. ( "
O ner a Name and Address..
Registered Architect and /or Engineer
Name and address of Incensed contractor....: ®J
Location and legal description of lot to be on:
Lot JAY-4.3 Block Subdivision
Street and Number where work is to be done
done
11 ®b hjirt4<,
and for no other purpose.
New guildhall ...._... Remodeling. Addition Repairs No. of Stories
To be constructed of Kind of foundation
Estimated Total cost of improvements $ i3 0 " bcir Amount of Permit $
Zone cubage required. ........__. . _ .... -.Plan Cubage
Distance to nest nearest ........._ ................ ...... .....__....._._._..._Site of Budding Lot
Maximum live load to be borne by each floor..._ ................ _....... ......_ _.._... ».. .._.......;
I hereby submit all the plans and specification few said building. An notices with reference to the building and its construction may
be sent to �. .........._ .._........
The utederdgnod apQ net for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under thhee info Workmen i Compensation AM. being Section 5968, Compiled General Laws of Florida, Permanent Supplement.
and has complied with the provWens thereof, and will require similar compliance from all contractors or eub.contractors employed by him
in the work to be 'pert sunder this penult: and win pest or cause to be posted for inspection an the We of the work such puhlic notice
or notices as aro required by the Act. The undersigned agrees to employ only sue ; nractors, work to f perfonned under this
permit, as are licensed by Miami Shores Village. i � , a ,
Remarks..._ ........__. _.........._......__... (Si
Disapproved .-....
(Signed) ..... d g ins
44M) Date ..._... 1� a
. No / " .? Street.
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and
submla tted fo the band -
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A copy of approved
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared - _.
to me wen known,
and who,. being by. me first duly sworn, upon oath deposes and says that he is the
of the above deaeribed 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. ( 7.... Date . _ .._... Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
NING BOARD......- ....... DATE
Chairman ! Member
Member ...._- ........... -..... Member ..-
Member ._.._ -.. -. Member _............
Council Approved....... Date Disapproved Date
NOTE: A charge of $1.00 will be mach for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re•insDectic fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials aaof /or workmanship.
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