ROOFINGPermit No
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the 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 1uilding Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept building during progress of the work.
Date , 19._K3
Owner's Name and Address .. naI.7 °' . _ o tc T o .l y No..__ ___ Street_/VC 7
Registered Architect and /or Engineer
Name and address of licensed contractor__
Date.
ding Inspec or
ty
0
Location and legal description of lot to be built on:
Lot Block Subdivision
^ � e
Street and Nurmber where work is to be done 7 70___. t L ?_7__
State work to be done and purpose of building (by floors)
. q- - oc!,./_A/:c i{Es/,OCAL / - 3c , -� 7 /- 96' #
5141-r6
t`/ s'4. /1_�1 A�.- / 7 L and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be. constiucted of Kind- of foundation Roof vering Z2 .. L'
Estimated Total cost of improvements $../ I
Amount of Permit $. .__i
Zone cubage required Plan Cubage
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
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 he 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 b Miami Shores Village. � �(
Remarks - --- (Signed),tR:�"- __.; 4!/_4 tz
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Date r — °Z 7" 6 3 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member ...... Member
Council Approved 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- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or fa
materials and /or workmanship.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
APPLICATION FOR BUILDING PERMIT
Owner's Name and Address A f /11 r r No. Street
go 'v
Registered Architect andior Engineer
/3 b c
/' /t �' l o y 1f / /V 13 y7 F� F'A.33) e
Name and address of licensed contractor M
Location and legal description of lot to be built on:
Lot
Hot Block 1 Subdivision r v 3
9 l / 0 , 57 7
6 )4/ 3l 7-id
' /
Street and Number where work is to be done 9 c-) ) r 9
State work to be done and purpose of building (by floors). state exterior colors (submit samples) /.Q W1(71/,Q C (9 f Oc 7 / /J 014,
lJgt e. Aen a. .a.Xz2.7, cL .f' a e. S /11 and for no other purpose.
Repairs No. of Stories /
Roof Covering —
// �Yln rrrhy(/
New Building
To be constructed of Kind of foundation
Estimated Total cost of improvements S ! as r7 Amount of Permit S
Zone cubage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all 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 obligatons 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 subcontractors, on work to be perfumed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
J ss
Remodelin
2 19 C & Addition
Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared
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 carefully read the foregoing application. and that he did sign the same, and that all facts therein by him stated are true.
Permit No. 39 94 1 DateJ
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date 3
Read. Sworn to and Subscribed before me.
Disapproved ' Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of 525.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials andbor workmanship.
Notary Public. State of Florida
19