25108MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or we plans and specifications herewith submitted for the build
in 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 specified or not. A amy of approved
plans and specifications must be kept at building during plogress of the work.
D ate—OOMMONIAuts...150MMOIMMOONMONOWOOOMMONOINDMOMMOINIO••• 10 19.a
Owner's Name and Address noml...ebozeta_fraartarian_allurch..—..._ No._
Registered Architect and/or Engineer 0000 00 0000000 • 400b ••••••serst••••••“•••tve•mietnirewt•rnmeserrttetr
Name and address of licensed contractor gaZCIAb.-R170111/8
Location and legal description of lot to be built on:
Lot.. Block . Subdivision. -- —■•••••••••• 000 0000000040000
Street and Number where work is to be done--.......... 602 .1g 96 Pt•
State work to be done and purpose of building (by floors). — ZgrAving.....
- for no other purpose.
New Building Remodeling -- Addition Repairs'. X No. of Stories ......
To be constructed of Kind of foundation......__ . — Roof Covering. .gignYg ••■■
Estimated Total cost of improvements ................ ------Amount of Permit
Zone cubage required
Remarks.
Before me, the undersigned authority, a note& public, duly authorized to administer oaths and take acknowledgments, personally ap-
STATE OF FLORIDA,
COUNTY OF DADE. I SS '
peared
Distance .to next nearest building Size of Building Lot. 00.0000,0000.000000000000.0000.00 0000
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 labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennancnt 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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
.Plan Cubage
(Signed)
•000 0000
000•0000000000000000000
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 ef y read the foregoing application, and that he did sign the same, and that affacts
therein by him stat
Permit No.. Read, Sworn to and Subscribed before me.
Disapproved _ ....... Date
Notary Public, State of Florida
(Signed) .—..—.--
g nspcctor My Commission Expires
PLANNING BOARD.. --
0000000.01.0000MM■460.10
Chairman 000 *00 00•04.000 .0**00000000. Member
Member • -_ Member
Member .000000 000 00000*0000 Member
Council Approved 040.00164. 0000.0•0000 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-impeetion fee of $1.00 will be charged when such re-hupection made necessary by Improper notice for inspection or faulty
materials and/or workmanship.