MECHANICALMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the appro\•al of the detailed statement or me 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 VI'Lige, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and ail 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.
R Date.
Owner's Name and Address4JC.� ... � � r.� .».� No.. � »__. Street. ».... Q.25-
Registered Architect and /or F:nglnce>' ���
Name and address of licensed contractor. I it
Location a Legal description of lot to be bui
Lot .... Block 1..... � Subdivision. ,
Street and Number where work is to be done .../
State :ork • be done andurppse of building (by floors)
Chairman
Member
Member .
Building Inspector
J., cam..
PLANNINC BOARD
ecse
_ _.._.. _.___. ........and for no other purpose.
New Building Remodeling Addition Repairi No. of Stories
Covering
To be constructed of Kin of foundation
Estimated Total cost of improvements .... ..L„At ; .,l ou f ..Amount of Permit $..
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 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 Libor under the Florida Workmen's Compensation Act. being Section 5966, Compiled General Laws of Florida, Pennane•nt Supfftle•urent,
and h,u complied kith the rovisions thereof. and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performe under this permit; and will post or cause to be posted for inspection on the site of the work su uhlic notice
or notices as arc required by the Act. The undersigned agrees to employ only su su ontractors, on work to be • f.i k .der this
permit. as are licensed by Miami Shores Village.
Remarks...
DATE
STATE OF FLORIDA,
COUNTY OF DADE. ss•
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared — . _..._..._.
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.. QQ � /
Permit No.. i./ _ ...+,... Date i vL U L° ._ _ Read, Sworn to and Subscribed before me.
Disapproved � ..,. Date..__.. ._ _ ._..._..».
', / V)/ v' U
(Signed) - ......... t...
Notary Public, State of Florida
My Commission Expires ...._._
Mcmbcr ? —
...
Member......._.... „.._
Member
to me well known,
v
Council Approved _. Date Disapproved Date
(.)T1- A charge of $1.00 will be made for making corrections or changes to this application after approval has hecn obtained from
the 1'I.rnnit.:4 l /u.ud.
A re Inspection fce of 51.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials anu /or workmanship.