23334BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement are me 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 Villar shall be complied with, whether herein specified or riot. A copy of approved
plans and specifications must be kept at building during pregreu of the work.
Owner's Name and Address eL42.M...547(..e..t.,
Registered Architect and/or Engineer.....0.3.4.S.0-49..
Name and address of licensed controctor....ea,$41..—
Location and legal description of lot to be built on:
Lot Block— Subdivision
Street and Number where work is to be
Staty work to be done and purpose of building (by floors). 4.0-2, irAd.
New Building RemodCiing. Addition Repairs'. No. of Stories.
To be constructed of Kind of foundation....— .. ....-. 129of Covering.
Estimated Total cost of improvements $..47t210-Cau.te-- of Pent*
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.. e. 3 4z.D 6‹4 6 .Q S iia(41:04 cD‘
The undersigntd 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 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 subcon: • 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 pubhc, duly authorized to administer oaths and take aeimowledgments, personally ap-
peared
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 carefull read the foregoing application, and that he did sign the same, and thatall - lac&
therein by him stated are
*
Permit No.. *Vf: Date... 1 1/ Read, Sworn to and Subscribed before me.
Disapproved
(Sigaed)
Building Inspector
Chairm . 0••••••• •••■••••■••••■••• a* 00.0*000 Member —.... • 0.0000 4101.00000.0•*0000• 000 000 • 00
Member —
Member -- —
--- ....—....Date Disapproved - - — - Date
Member
Me ber
Coon il Approved
MIAMI SHORES VILLAGE
••■•• 0000.
000 00 00 110 0000000
00.1 O. 00.0
PLANNING BOARD--
-----------and for no other purpose.
----DATE
Plan Cubage
000000.00.1■••••••••■••00000000•
Notary Public, State of Florida
My Commission Expires.
NOTE: A -charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re fee of $1.00 will be charged when such re-inspection is made necessary by improper notice
materials and/or workmanship.
0.000••••••••••
0,00,000
00, ••• 0s0
..to me well known,
has been obtained from
for inspection or faulty