17885Disapproved
(Signed) .
Chairman
Member
Member
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATICIN FOR BUILDING PERMIT
Application is hereby made for the approyal 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 o,f 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 spedfied or not A copy of approved
plans and specifications must be kept at building d ng plogress of the work.
Building Ins
PLANNIN
or
*t.4 4
Owner's Name and Address \ VINA.
Registered Architect and/or •••• ••••• •- •sos.. \ ia.. . I ••••••.reanti• .. ntinerterirt.sgyittsammtre
Name and address of licensed contra...„,Q
Location and legal description of lot to be built on:
Lot- Block. Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
.....
kv„L ate
.,,
0
Remarks
Member
Date Disapproved
Public, State of Florida
My commission Expires
OARD_ DATE
Member
Member
NOTE: A charge of 51.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re-inspcetion fee of 31.00 will be cheiged when such re-inspection is made neeessaiy by improper notice
materials and/or workmanship.
and for no other purpose.
New Building.... Remodeling Addition Repairs: No. of Stories
To be constructed of Kindlf foundati Roof Cove0.0
Estimated Total cost of improvements 5 *11 'T) 11 " Amount of Permit $t.
Zone cubage required 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 ifications for said building. All notices with reference to the buikling 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 penult; and will post or cause to be posted for inspection the site of the work such public notice
or notices as are required by the Act The undersigned agrees to employ only su k to be performed under this
permit, as are licensed by Miami Shores Village. -
STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments; personally ap-
peared .
to me well Imown,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described constriction, that he has carefully read the foregoin Plication, and that he did sign the same, and that all facts
therein by him st e g
/
Permit No. and Subscribed before me.
Date
has been obtained from
for inspection se faulty