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APPLICATION FOR BUILDING PE2MIT
Application is hereby made for the approval of the detailed statement of the plans and specif:,;ations 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 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.
Owner's Name and Address 'J t L 7
Registered Architect and /or Engineer
_
Name and address of licensed contractor__ ∎1 , _ t _ /..'
Location d le a1 description of Iot to be built on:
Lot_ , ) i i Block , , Subd C AX/ __ �tiGtil?.
Street and Number where work is to be done
State work to be doe and purpose of building (by floors)____
New Building v Remodeling Addition Repairs No.. of Stores s 1
Kind of foundation Roof Covering lef .i
Estimated Total cost of improvements $____ 0 _ _________ ___ Amount of Permit $ /I
Zone cubage required____ l
1 0 0 T _____ , -_ . Plan C _
Distance to next nearest ding -- d - - -Size of Building Lot - 2 t- 3C y
Maximum live load to be borne by each floor
I hereby submit all the Cans and specifications for said building. All notices with reference to the building and its construction may
To be constructed of_
Disapproved Date
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
and for no other purpose.
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Street_ _____!
Notary Public, State of Florida
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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 5968, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub _contractor employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the si 4 the wor such .ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on r jp/b . r.. under this
permit, as are licensed by Miami Shores Village. 1 �,.
Remarks ( Signed) 1 --"7” � i" 6
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STATE OF FLORIDA,
COUNTY OF DADE. s9.
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 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 Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member T_ Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will. hp 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 wherf such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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