MECHANICALMIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Applicati$ hereby mode for the approval of the detailed statement ur the plans and specifications herewith submitted for the build •
ing or ottPt str' ,iare herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Vct1' e,'rlorjd.e, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulation the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and s vifications must be kept at building during prggreu of the work.
Tilt" Date..._... F _____. ,19.oi
Owner's Name and Address .... .. A-) 4 •......__ ...._ No/2L. 41 :E: Street._... 6 ._S -e" r
Registered Architect and /or Engineer „•,. ,,,•••,.,•,,,,,,,,,,,,,•.•,,.
Name and address of licensed contractor a . .._. �/� �'Ja' .... ! O O S - &O ,4E'.
Location and le I description of lot to be built on: � � Q
Lot.1 7 L 'g �I /. /Q. Block .ge Subdivision �'l..:a?.•• ! -- . ti X206 /y
Street and Number where work is to be done /2/ O A cc 5 6 .._. s7
State work to be done and purpose of building (by floors) - - L A ) S 4 LC. r1041 The .L- 7 zoo._7 -4 S SPG F - _
4 y i
___ __..._........and for no other purpose.
New Building Remodeling Addition. ) Repairs No. of Stories _
To be constructed of Kind of foundation lloof Covering
Estimate /
Total cost of improvements ! So — Amount of Permit S. 1 \' . - 0 0'
Zone cubage required Plan Cubage
Distance .to next ne.uest 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.
BUILDING INSPECTION DEPARTMENT
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 5e966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the ite of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ntractors, on •rk to be performed under this
pcnnit, as are licensed by Miami Shores Village.
1 c.
Remarks (Signed) "
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 carefull read the foregoing application, and that he did sign the same, and that all facts
thcrcin by him stated e. .
Permit No ._.. Date t Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Building Inspector
Notary Public, State of Florida
My Commission Expires .._._
__ ..to me well known,
PLANNING BOARD DATE
Citairrnan Mcmbcr
Member 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 nfter approval has been obtained from
the I'Lennir.g Board.
A re 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.