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Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or Inc 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.
Date..._..._....__......_._ ( _L0 .__ .. iB f -
Owner's Name and Address :L. e..I - : - r it'., S... ..__ ® QQ
. .. No.a.. ._.._.. Str • I
R egistered Architect and/or Engineer .fin _ ,:,. ........ ,.,,,.n . r ..............en,,,,
Name and address of licensed contractor.. ° 1 D P4 ° li ! - �.4a.a 1/U. a
Location and legal description of lot to be built on: _
Lot 7 Block ZO Subdivision
° . ° S.1'12.. � ®S e a
Street and Number where work is to be done Ain...Ar Q �� g-r-
State work to be done and purpose of building (by floors)...... i. L _..f_e- n
and for no other purpose.
New Huikinn Remodeling . . Addition Repairs nsQ No. of Stories _
To be constructed of .... -.. /L. Kind of Corr C / ... aloof Coverin °
Estimate Total cost of improvements $ � ( . V Amount of Permit $. .._ J . . . .i..
Zone cubage required plan Cubage
Distance .to next nearest building Size of Building Lot. ...`1.C. 9x.. X1.F.:5
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..
The undersigned applicant for this building perinit 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 .. ith 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) .�
Building Inspector
Date
Notary Public, State of Florida
My Commission Expires _._.__ _........._ _
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
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.. q
Permit No. . -4))6'3 Date. . . ` '� . iT 5 Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Mferr,ber 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 limn
the Plannir.;; Board.
A re- inspection fce of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and/or workmanship.
(Ur
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SHORELAND BOULEVARD
LOCAT /ON SKETCH
20o'
23 1
M
S KETCH OF SURVEY
OF
LOT L BLOCK Q
MIAMI SHORES
SECTION NO. I
RECORDED /.V PLAT BOOK /0 PAGE 70 OF THE PD'BL/C
RECORDS OF DADE COUN7Y, FL R /DA•
/VOTES: COWTA /M /NG 5,750 SQ FT. MORE OR 1 55.
LANDS s//O/W/A/ HEREON WERE NOT ABSTRACTED FOR EASENEA/7S
AND /OR R /STS OF 14/Ay OF RECORDS.
CE/?T /F /C.4 T /ON :
WE HEREBY CERT /Fy 77/AT THE ATTACHED "SoCETCN OF
OF THE ABobE DESG? /BED PARCEL OP LAND /5 TRUE AND
CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF As
SURi/EyED A/OJ'EMGiER /4 /984 (/NDER Oche D /RECT /ON AND
COMPL /ES /I//TH TA'E M /.✓ /,.p 7EGVN /C,4L STAWDA, ' SET FORTH
By 77/E STATE OF FLOR /D.4 B04RD OF /AND SURVEYORS.
DAN /EL C FORT /a/ _ V /CE PRES/DEA/T
REG/sTEREo LAND S7/RYE'OR N/7. 2653
57AT• OF FLOA?/DA.
MOT ✓AL/D UNLESS' SEALED
Fortin, Leavy Skiles, l nc.
Con.u. Engineers nQH16.,n ab Ulric! stm.yon
0 63S (ouch Federal NI6n ,.1 Boca R.lon, Florida 33432
160 Nortit.rsl HAM Street , North latent! Saar+. Ronda 83162
O.C. 633 -4487 / d+or.rC 18}91611 / Boca RA tOn 333 - 1313
Date kola dot No I Dal
//- / i , /".% 20 I 434/650 /84