22918STATE OF FLORIDA,
COUNTY OF DADE.
Member
Council Approved
Maximum live load to be borne by each fiber
uilding Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statereem or we 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 Villa% shall be complied with, whether herein spedfied or not. A copy of approved
plans and specifications must be kept at building during p gress of the work.
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Owner's Name and Address ..
Registered Architect and/or Engineer ....... -.......--__
••-• t • ••••••••ister• • •vt, ••1 .. • ... vorrtren.tnnetstswernsts "
Name and address oNicensed
Location and legal description of lot to be built on
Lot- Block- - Subdivision —
Street and Number when: work is to be done 4 €7.7 /fr- 47, 7 4_5.17 .._ W
.....-.
State work to be done and purpose of building (by floose).-.‘fi...222.2a.e.-
...
422e '217- *--a 4 449c- /
New Building Remodeling X.... Addition
To be constructed of C-4‘...T Kind of foundation --e-11-/57..4'
Estimated Total cost of improvernents
Zone cubage required
Distance .to next nearest building
OOOOOFFOOFOWN.WWIFFOWIWIlONO
Disapproved -- . •••••• Date.-- — •
(Signed) .---.--
--Size of Building Lot. —
PLANNING BOARD..
Chairm — ww0OWOO FON • aowwwww*www■owaro•Ow Member
Member OW *NOW. ONoo•OF• •■•■•••••■ *WNW. Member
Member
(Signed)..
• ----and for no other purpose.
Repairi No. of Stories.
of Permit L. 000041100XIMMOOONO .0 OA.. 0•011.0/DO ONO*
— _Plan Cubage
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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. 3 6 64 .-i V S2 A T 410 •
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, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub enmloyed 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 such subcontractors, on work to be perfonned under this
permit, as are licensed by Miami Shores Village.
Remarks.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths- and take acknowledgments, personally ap-
peared
-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 that all acts
therein by him stated are true..
Permit No. ° Date..
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
amOOO•WO
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 tor inspection oe faulty
materials and/or workmanship.
PLANNING BOARD AGENDA OF OtI' ( 3, 1 ITEM NO. t
Name of Owner /Appl i canteilA. ! , PCt9131. Q %URCI} Phone No. 1114--(45th
Address of Property, and /or Legal Description W A . Ni S. Qt, 5'Ti
• aliami cfhores
F L OR ID A
Nature of Request A ?PRUvA1.-- O PlAtft FIRmwrio^ WILY 41"(td"
Present Zoning R.--15
Area of Present Building
Area with Proposed Addition
Parking Spaces Provided
Parking Spaces Required with Addition
NIR
Setbacks as per Code 5S .V. . a'T`TF}C)31 r' TRON1 3..p - r of .s -r4KG
Setbacks Provi ded
Variances /Exceptions /Zoning Change
ft'. epiA t 'f ►0 m 'Ott avP - r. g q' M .' TIN o
Counci 1 Action Requi red
Date of Applicant Notification
Planning Board Action Po'tN,D
Council Action
4t,60
Director of Building and Zoning