857 NE 97 StSTATE OF FLORIDA)
COUNTY OF DADE )
are true.
Member /?f
Secretary
I
BUILDING PERMIT RECORD
MIAMI SHORES VILLAGE
FLORIDA
DATE
APPLICATION
Applica'io is hereby made for the approval of the plans and
specifications herewith submitted for the building or other
structure herein described. This application is made in com-
pliance and conformation with the Building Ordinance of the
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 reulations of the building
Department of Miami Shores Vil age, shall be complied with,
whether specified or not.
;c" 4;
OWNER r
ARCHITECT !• ?!; CONTRACTOR � (�yG;!
. r - f
LOT, V! . . - ' BLI{ f�. SU3 DIVISION ',' 4/' ' JSTRW «: y>
NEW ( ADDITION REPAIRS °" NUMBER OF STORKS ROOF
COST (ex-oIuding -- Architect's fee , landscaping & garage)$
- -
Building to be used for ' G "'/ - _. =Y-- '
I hereby submit all the plans, and specificatic
building.
•- •" A
4 .
Signed /
Before me, the undersigned authority, a notary public, duly
authorized to administer .oa hs %ta e acknowledgment,
personally appeared 7 '� to me well
known, and who, being by me fir duly sworn, upon oath
deposes and says that he is the uilder of the above described
construction, that he has read the foregoing application,
and that he did sign the same, and that facts stated by him
Read, Sworn and Subscribed before me, �-
My Commission expires r,
Cubic Feet - /) Cubic feet required in
/1 i PLANNING BOARD
Chairman
Memb _
Notary Public (Signed)
and no
Electrical Permit No. Plumbing Permit No.
other
this Bloc
i
Building Inspector
Permit No.,__L5 Issued to Date %
use.-
Painting
Plastering
Lathing , .
Electrical
Mason & Concrete
Plumbing
Roofing
s . Glazing •
- Tile
Miscellaneous
LIST OF SITE-.,CONTRACTORS