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MECHANICALSTATE OF FLORIDA, COUNTY OF DADE. ss. Disapproved (Signed) MIAMI SHORES VILLAGE �S 3�3 BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement ne or erne 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 Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address .. :.,t? IA ./K.i _ No... ll..7... . _. Street Z �� . _. Registered Architect and /or En IMcer 111:1 . . -. ,11, ,,11,71.. ., .:,.,•7,. Name and address of ltcenseantrgctor � / rip N!C'�_.. Location and lega description of lot to be built on: Lot.4.j. ` `'t . 3.. Bock 7 Subdivision.. / fl . t.9 e Street and Number where work is to be done _1111__ State work to be done and purpose of building (by floors) ...... S.irRlJ Ce —ri -' 1 11 11.»....�r 2..L ®,atl1�r ✓.�^'1�G _1111__ and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit Zone cubage required _Plan Cubage Distance .to next nearest building Size of Building Lot .......... ...... ................... ------ Mfaxirum 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.. . 1111.. 1111. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of Libor 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 subcontractors, on work to be , performed under this permit, as are licensed by Miami Shores Village. �� „ — � % %r,Gj •-� Remarks (Signed) e 6-d /\5 - 7 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.. Q� Permit No X/ Date 3t ! Read, Sworn to and Subscribed before me. Date Building lnspcctor Notary Public, State of Florida My Commission Expires _ to me well known, PLANNING BOARD DATE Chairman Member Member Member Member 1111 1111 Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will he made for making corrections or changes to this application after approval has been obtained from the I'I.innir.g Board. A rc•inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspectitm of faulty materials anti /or workmanship.