1279 NE 97 StMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application 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, wh ther herein specified or - not.„,1 copy of approved
plans and specifications must be kept at building during progress of the work. r - '
Date i y .
, 19
No Street
Owner's Name and Address____ `
n
Registered Architect and /or Engineer
Name and address of licensed contractor______
Location and legal description of lot to be built on:
Lot Block Subdivisio
--
Street and Number where work is to be done / v
y '
State work to be done and purpose of building (by floors)__
and for no other purpose.
New Building C'% Remodeling Addition j� z Repairs No. of Stories_ 1
To be constructed of__�__ —s' r _ Kind of foundation__ � ��% ' �L____ .��__L�� "--� � el Roof Covering
Estimated Total cost of impr
Zone cubage required
Distance to next nearest building
Maximum live load to be borne
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
ements $__
ount of Permit $
__Plan Cubage__ _�_
of Building Lot
by each
t}
oor__:
I hereby sub t all the pla�r�s and pbcifisatipns for said 'wilding. All notices with reference to the building and its. construction may
i1�o�n F' ) : " -
be sent to
The undersigned applicant or 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 erfiployed 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 c notice'
or notices as are required by the Act. The undersigned agrees to employ only such siibcontrrctors,,on work to,be.- .performed under- this
permit, as are licensed by Miami Shores Village. / 7
Remarks — (Signed)_
G /
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_
,— /
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, upo oath deposes and says that he is the
of the above descr bed const�tion, that he . s carefully read th ,fforegoing application, and that he did sign the same, and that all facts
therein by him „sta{ ed itre$q
Y c �
htil
Disapproved ,
( Signed)
1- e .
�zc'5':.2
•
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Ag
__to me well known,
Building Inspector My Commission Expires
PLANNING BOARD__ DATE
Chairman 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.