1270 NE 97 StMIAMI SH ORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Apnlication is hereby made for the approval of the detailed statement of the 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 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
Registered Architect and /or Engineer
Name and address of licensed contractor_________
I
Location and legal escription of lot to be built on:
Lot /3__� / r ' p__44
` 4 __ Block
Building Inspector
c /r
t
Subdivision_
Street and Number where work is to be done______Lg_ y' % =
State work to be done and purpose of building (by floors)
New Building ° Remodeling
To be constructed of C ' B 'S Kind of foundation
Estimated Total cost of improvements fir'
Zone cubage required____ 5.0 0 0
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building.
be sent to
Chairman
Member
Member
Council Approved
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Date
Remarks (Signed)
and for no other purpose.
Addition Repairs No. of Stories
j LO • CO kl C. Roof Covering m CI t- r , y t a=
oc7
Amount of Permit $_.._...
plan Cubage____
Size of Building Lot 1 10111 '_1_•_ _lc d _ _________
All notices with reference to the building and its construction may
The undersigned applicant for this building perrnit 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 sit of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ( su contractors, on world to bejperformed under this
permit, as are licensed by Miami Shores Village. ■ " 9 )
Member
Member
Member
Date Disapproved
7
PLANNING BOARD .____DATE
No Street__
Notary Public, State of Florida
or changes to this application after approval
M
19
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned 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.
Disapproved Date
(Signed)
My Commission Expires
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty