12498 (2)d specifications heCaVvitb,. submitted for the build -
orrmiity with the . Buff (hdmance of Miami
ces of Miami Shore . :1 all rules and
ther herein specified o "' .a copy of approved
MI *MI'SHORES VI
BUILDING INSPECTION DEPAR
APPLIC tIDN FOR BUILDI
Application is made for the approval of the detailed statement of the plans
ing or other' structure herein described. This application is made in compliance and
Shores Village, "Florida, and all provisions of thhe Laws of the State of Florid all or
regulations of the Building Division of Mean Shores Village shall be complied with, w
plans and specifications must be kept at bul g during progress of the work.
Owner's Name and Addrass
Registered Architect and/Cr 1 Engineer
Name and address of 'licensed contractor
Location and legal description of lot to be built on:
Lot Block _ Subdivisi
Street and Number where work is to be done - n • C , Rte' GP
State work to be done and purpose o building (by floors
and for no other purpose.
New Building Remodeling ' Additi on -� - `R No. of Stories
To be constructed of P, S - Sind of founda ® `''°`M- Roof Covering ,
E Total cost of improvements $ _,. Q Amount of Permit i r Ro 1 C.
Zone cubage required Plan Cubage '
Distance to next nearest building Size of Building Lo
u
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications far said building. An notices with r
be sent to
T a undersigned a.. cant for . , building permit does hereby certify that he and ands and accepts his obligation$ as an employer
of labor under the Flori. Workmw;'s Compaisation, Act, being Section 5968, Compiled Ed t Laws of Florida, Permanent S i .•.lement,
and has complied with the provisi . thereof land will require similar compliance from all contractors • sub- contractors 'am ploy • by aim
in the work to be performed under this permit; and will post or cause to be posted insOnction on the to of : work such public notice
or notices as are required 11)y the 1 Act The undcrsignec- agrees to employ only su ., � .nKra� s, .ii�w.� .i be performed finder this
permit, as are licensed byrMiami Shores Village.'
Permit No. /
Disapproved
(Signed)
Chairman
Member
Remarks
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,
ses and says that he is the
y read the foregoing application, and that he did sign the same, and that all facts
and who, being by me first duly sworn, upon l oath d
of the above described construction, that he has Care
therein by him stated are true.
wilding
J
.I
Date ✓ ` — J
Date
LAGE
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
• ecwz
PLANNING BOARD DATE
Member
Member
G PE R Iv11' -
ence to the building and its constructi
My Commission Expires
Member Member
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for miring corrections or changes to this application after approval
the Planning Board.
material
A re s and/or workm ono fee an o ship
f $1.00 will be charged when such re- inspection is made necessary by improper notice
,19_
may.
' Date
has been obtained from
for inspection or faulty