14694 (4)MIAMI SHORES VILLAE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMOIT
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 th' Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida all ordinances of Miami $ Village an all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein spee�it or not. A coy of approved
plans and specifications must be kept at budding during pitgress of the work.
Owner's Name and Address � ^'
Registered Architect and /or Engineer__
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot- .;__ .. Block.» ubdi jj sionye
Street and Number where ork is to be done ..9.6P- �,/
State work to be done an purpose of building (by floors) �._.C�.GC� . �'(g g
t-- ........and for no, other
...... pu:Pose.
New Building__ .....�...�. .... Remodeling..-.. ... d Repairs No. of Stories....:/ ..
To be constructed oCittiee Ki of foundation.KOMPil4tt 014 t.. ». » ....:.. Roof Cove n »
Estimated.Total cost of improvements $ /. �il��...Q.i ld ........_Amount of Permit L." 3.. ` /
.._._.__.__plan Cubage _..... _
Distance to next nearest building .............._._..._ ._ . ._._.....Size of Building Lot ....
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 tp
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 i omplicd with the provisions thereof, and will require similar compliance from all contr ctors or sub- contractors emplo d by
or notice's be by the Act. The undersigned agrees to employ only on post �' on site of t work o c .i ee him
this
permit, as are licensed by Miami Shores Village. .7J � �
Remarks _. (Si . _�'wt.�.aii�
STATE lOF FLORIDA :1
COUNTY OF DADE.
Zone cubage required.
. 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, 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 st are tru
. Permit 1 No
Date 2 7 '° ....:.._.... , i9..._...
. � 4/OJtisfi .it ✓ ' ...._._. / No..».... ... Street.. [ P ..... .jeje?e
._..... clime.............. ....mno...... M
f .-a ....... ». ..:.._.:....� ....
Disapproved. _....... Date.
(Signe6 )) .»
PLANK`
Chairman
Nfernbcr
Building Inspector
G BOARD.
_ »
— Member
Member
Member Member
Council Approved Date Disapproved
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires........»:.......
DATE
to me well known,
Date
:■OTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Boar
A re.inspecti i fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/Jr rkmanship.
2.7 x rya 3 fa. r
Po e A r 2..'z t IC - y.....--4 --
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