25221APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or me plans and specifications herewith submitted for the build.
inc 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 i3uilding Division of Miami Shores Village shall be complied with, whether herein specified w not. A copy of approved
'plans and specifications must be kept at building during progress of the work.
..- _ Date 6 —4-7-..191.Y
.-
4 Owner's Name and AddressM.EVALS.S.-
, owutoco
•••••• N011...6 0 2, 21/....t11-......—
Registered Architect and/or Engineer. —
N arne and address ot licensed contractor (1 C 0 9 Q.Ear....=...afti 1 ...k. ...P • „............................ ..... ..... — ..........
Location and legal description of lot to be built on:
Lot Block - .... Subdivision
Street and Number where work is to be done... .. NE - gerc- 1 ' 7 ' ''' .14164-.441 < CfeNi2 -. C, '3.' 31
State work to be done and purpose of building (by floors).--Q.... 5 1 ea 4.4...
ebF UT: kr 6 ti--uF" ..51-...1.C c .f..... .... ...._.
and for no other purpose.
New Building
Remodeling Addition • Repalrs No. of
To be constructed of Kind of foundation.. — Roof Covering.
-2c-20
Estimated Total cost of improvements $.1.2434 *ON Amount of Permit
••■•••■••• ••■•••••••■•••• ••■•••••■•■••••■• ONMON
Zone cubage required . — ----Plan Cubage
Distance .to next newest building
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, 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 bperformd • under this
pcnnit, as are licensed by Miami Shores Village.
Remarks.-
STATE OF FLORIDA,
COUNTY OF DADE. SL
.Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, 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 carefully read the foregoing application, and that he did sign the same and that all facts
therein by him stated are true..
Permit No..
Disapproved —
(Signed)
Chairman
Member .
Member
Council Approved
Date....
Building Inspector
NOTE: A charge of $1.00 will be nutde for
the Planning Board.
A re-inpcction fee of 31.00 will be charged
materials anti/or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Size of Building Lot. ..—„._--
(Signed)
PLANNING BOARD. ....
Member
Member
Member
— Date Disapproved —
Te• •rn mt•temerrInetot•impersireserntle.
OW ••••1 .11.
**No ■•••••••••••••••••••■••
-- DATE
au%
( at -7 s Pi-D.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
to me well known,
My Commission
Date
making corrections or changes to this application after approval has been obtained from
when such re-inspection is made necessary by improper notice for inspection oe faulty