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I. B. FORD
1712 S. W. 1st Street
Miami 35, Florida
Telephones: 9-3508 7 -2524
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I HEREBY CERTIFY that the attached sketch represents
a survey made under my direction and is true and
correct to the best of my knowledge and belief.
There are no enema tr, ex evt/4s sh4�vin.
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According to the Plat thereof as recorded in Plat Book
Public c *cords of Dade County, Florida.
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REGISTE D . ND $GRVEYOR 4h;
STATE OF FLORIDA
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Date c-''y 4'/950
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MIAMI SHORES VILLAGE
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, 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_
BUILDING INSPECTION DEPARTMENT
Date
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be bu t on:
Lot___ L_ 1_ -S___4 • Block Subdivision__
Street and Number where work is to be done
State work to be done and purpose of building (by floors)_ ,��•� - <
New Building Remodeling Addition ..
To be constructed of d-8 S Kind of foundation ( �:rLi- -tom _
Estimated Total cost of improvem ents $__I/ D O O • ' .
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STATE OF FLORIDA,
COUNTY OF DADE.
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Chairrn
Member
Member
My Commission E
PLANNING BOA D DATE
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Street
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and for no other purpose.
Repairs No. of Std s J
Roof Covering - e!_ -P!�
Amount of Permit $
Size of Building eot
Zone cubage required
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. All notices with reference to the building and its construction may
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 w 11 post or cause to be po 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 k bcontr�� tors, on }pYO k to be performed iync er this
permit, as are licensed by Miami Shores Village. C
Remarks (Signed) � ti ._(j ( /�1� _ w' 1 _ /� i
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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 r (duly sworn, upon' th dews s and says that he is the
of the above described instruction, that he 11a caref I read the foregoing a plication, and that he did sign the same, and that all facts
therein by h n stated ai' tru /
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Permit No.. 9 47 / ► � afA ` ` i 1 ,� 4 1 r -1.' Re si;orn to and Subscribed before me.
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Disappr
� ] Notary Public, State of Florida
(Signed pec r ` L4 .* 1�
Building Insto xpires ------------ ------ -----------
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.
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