23298BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed state or tree plans and specifications herewith submitted for the build •
ing or other structure- Iuiein 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 specified or not. A copy of approved
plans and specifications must be kept at building during *gross of the work.
Owners Name and Address ..../. 4' 1;a/. .�..,, ZS -. ` No. ».ae ; Street.... « • ««1111....,.
Registered Architect and /or ngineer••••4.4/.? ...�.!' Pd.?.ii ....A , Q %► `
. «. _ o .11.•
Nature and address of licensed contrgctor« ._ - , 1 . •�. a.....97.610 0 1 ' ' 1nc4#' - .. ...a ice, •11 , 1 ,
Location and legal description of lot to be built on:
Lot— Subdivlslon._. _11_
Street and Number where work is to be donee . e /_ 4 ��. .«.....».....«
State work to be done and purpose of building (by floors) /�� ' R_._...
,. E r_.. 11 11 cg ... « 1111«...,.« « _ ............:............. «1111.... «.
R emarks. « «... ■••• ......-
STATE OF FLORIDA, .
CQUNTX OF DADE. m '
peer . --11_11— « . «.....
Disapproved —
(Signed) ._.—.
i
i MiAMI SORES VILLAGE
Building Inspector
, Date.
,..«,... Date ....«... ..
(Signed)
Date
•■••••• 000000000000 « .................... «.1.« 11. «1111..... 1111...« ............._...« .:,..,. for no other purpose.
New Building Remodeling.. . « Addition Repairs.. .. No. of Stories--
To be constructed of Kind �� o � ff foundation«.«« Covering
Estimated Total cost of improvements $ ... ...t�,..0?. ®.9 ° .. ...Amount of Permit $.....17 4 1111,.,. .....
Z one oubage required �.».».«..........21an Cubage «_..._. «. ._........._.. .. „. .... ...
Distance .to next nearest building. »«11«11....« Size of Building Lot. ... 1111... «
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 permit does hereby certify that he understands and accepts his obligations as an employer
of tabor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sep tlrment,
and has complied with the provisions thereof, and will require similar compliance from all contract or sub contrectors employed by hint
in the work to be performed under this permit; and will post or cause to be posted for inspection on t site of•the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such • tractors, on k to be under this
permit, as are licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ep-
_._ «.......,.. to me well lmown,
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
therein by him stated are tru
Permit No..
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires....,.,_........«
•PLANNING BOARD.— ......... .«...._.___DATE
.•11._..■.11■
• «. .«........ ..0110... Member ..... ....«««..........,_.»««.,.......« .,- «,...»._..« ................. «1111
«. .._.«...,_......«. Member «......«.........»......•.
• ...«..,... 611.0.» «.. «.1111.
w ••••. -11•••• Member
Chairman 1111
)Icrrber
Mernber
C ouncil Approved . « ........ .... ....««....Date Disapproved ........ «.. ».... ««„« ..«...... «..,. ,•Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application afters approval has been obtained from
the I l.innir,;,t Board.
A re- msp(.ttion fee of $1.00 will be charged when.auch re•inspection is made neceatary by bumper notice for inspevvtian our faun)
materials anti /or workmanship.
..........:... ••••••••11.,.