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19828ALI — 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 spedfied or not. A copy of approved plans and specifications must be kept at building during *gym of the work. Owner's Name and Address .e.#111..!. . Registered Architect and/or Engineer ..... r4 - nr-itteil. frr•Ve AV " • ,nnattit TIMM ...Mt .1.110411141M. tV111,11111tell.11.. Natne and address of licensed contrtictors1.710.-ita 2 44101 • stftiArX-•--(t-4---./-4:2-14A--4('‘"41-- Location and legal description of lot to be built on: J Pi - Street and Number where work is to be done 96.....st3 Lot Block. Subdivision State work to be done and purpose tr New Building. Rem f 943.—ate_i 4.1749(' ,----;;"- 3;'° MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT d,building (by floors). atif..A.atelya." .. and for no other purpose. odeling.. Addition P Repairs' No. of Stories ...... To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $....4.*...40.42-12 of Permit $.. 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 sujamit all the plans d specifications for said building. All notices with reference to the building and its construction may be sent w...4.7.7411.After__ AP eltga • r eestM" • Cie • 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 Sup and has complied with the provisions thereof, and will require sunder compliance from all contract or sub-contra ors empl in the work to be perfonned under this permit; and will post or cause to be posted for site of ork suc or notices as are required by the Act. The undersigned agrees to employ only such work permit, as are licensed by Miami Shores Village. Remarks peared STATE OF FLORIDA, COUNTY OF DADE. f s Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- Disapproved (Signed) . el/e)io< xx-- 19 22 Date Notary Public, State of Florida My Commission Expires DATE lenient, by him is notice - this 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 stad are true. Permit No. Date / 2 "7 Read, Sworn to and Subscribed before me. Chainnan Member NIernber 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.