1250 NE 97 StBUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILD N1 PERMIT
Application is hereby made for the approval of the detailed statement of the plans an speci ica:ions 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 Vela e, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations o Building Division of Miami Shores Village shall be complied with, whether he: eiri specified or not. A copy of approved
plans and speci ions must be kept at building during progress of the work.
Owner's Name and Address }''
Registered Architect and /or Eiig la_j
Name and address of licensed contractor � Lz+Lf '
Location and legal description of lot to be built on:
Lot ' '' i �' Block Subdivision
Street and - Number where work is to be done
State work to be done and ose of biuldin
PmP g (by floors) —
STATE OF FLORIDA,
COUNTY OF DADE. ss.
$tiildmg Inspector
MIAMI SHORES VILLAGE
Date
' No.,i
Street is \ j
,�-
G ,
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
2 foundation ' 1
' - Roof Covering / ' '
To be constructed of ° Y . Kind of ..L
Estimated Total cost of improvements $ ��,
p �} e ' Amount of Permit $_�___
Zone cubage required 4 - t ' 1 " _ O' 2-^ r
_
— — — _Plan Cubage — 3 rr. -,--c ,
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
0 be sent to
The undersigned 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, 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 site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. •
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by p e first duly sworn, upon oath deposes and says that he is the
of the above ' descri cbvtruction, that he has fi c refully read the foregoing application, and that he did sign the same, and that all facts
therein by him s ted are tpue. fl
Permit No Date__ __ f ;4_)- lam 4 Read, Sworn to and Subscribed before me.
Disapproved I_ �% ' , Date
( Signed) - - - -- + > = --t4 `r • L
I
PLANNING BOARD ; DATE
Chairman' v Member
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 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.
Notary Public, State of Florida
My Commission Expires