19846MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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 oj Florida, all ordinances of Miami Shores Village and all rues 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 Owen of the work.
Owner's Name and
Registered Architect and/or
Is2„„(d01 1/0
Location and legal description of lot to be built on: O'fia
Lot-. Block.
Street and Number where work is to be P -6
Name and address of licensed convector
State wqrk to be done And purpose of building (by floors) De/e. _c' . E
eLF cazz.c.z. *AIX
and for no other purpose.
New Building Remodeling Addition Repairs' /d No. of Stories
To be constructed of Kind of foundation- Roof Covering.
Estimated Total cost of improvements $.. —Amount of Permft
Zone cubage required_
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 to
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisiosp 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 will post or cause to be posted 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 su bcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.. f ss•
Before me, the undersigned authority, a notary public, duly authorized to a
peared
4.11.••••
Subdiision
•
Date
,I927
No . ••••••■••■•••••••••••••••••••••••
6 4 4•••Cagtt.• MT•ifttferMeTtl
Plan Cubage.
„7: 406-42, c it 5'47-4s
Afr. Vad,
a l) r lie t . Rio y
minister oaths and take acknowledgments, personally ap-
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 stated are true.
Permit No. )5? 4 t' Date. . 1
Disapproved
(Signed) / ..--..... ........ ....... ..
.
Building Ins or
Chairman
Member
Member
Council Approved
PLANNING BOARD
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re-inspection fee of $1.00 will be charged
materials and/or workmanship.
Member
Member
Member
Date Disapproved
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
DATE
making Corrections or changes to this application after approval has
when such re-Inspection is made necessary by improper netts* for
• *
•••••••••
Date
been obtained from
inspection or faulty
17
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