FENCEOwner's Name and Address
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 Budding 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.
Registered Architect and /or Engineer , ,.,, ,,, ,,,,,
Name and address of licensed contractor D 11-> - -
Location and legal description of lot to be built on: '',,ss
Lot 1.Li Block ......SO Subdivision. fl.0 P y ��4 i�2?u S Sid _ C Q
�I
Street and Number where work is to be done.....` .._ s t y _hi...1.i .S..kwd.t...
State work to be done and purpose of building (by floors) /G4G4a—
.2r!'LtCQ/ �g / L .. _ = t s+Z .and for no other purpose.
New Building 7100 Remodeling `71.1:2 Addition 44 Repairs 7 No. of Stories. ...O/ —
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 7 5 751 O 0
Date 19 Cl/Jti,. _�........ _��..�� __ ..... ,
_ No.LQ a 0.__. Street.l!:f.E
Amount of Permit $.
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Mfaxirnum 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 pennit 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 s on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks._._ (Signed
STATE OF FLORIDA,
COUNTY OF DADE. j Ss.
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 s ted area e.
Permit No.____— � Date
i iv.
Disapproved ) . Date.._ - 7_ j 1 ,.
(Signed) [ll.G �. .. _ f
Butldt nspcctor
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
.. My Commission Expires
to me well known,
PL/PN BOARD DATE
Chairman �� Member
Member Member
Member ...... _.....— •-• --_ •-- - - - -_ -_ Member
Council Approved. Date Disapproved ............Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning hoard.
A re- inspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or worktnanship.
--
-
'fowl kasrist$is
Lot 14 is 81.ak 110 of WINO P1.12 OF TUT$ 17U1,
170C,17*4. $7!l,1Mw, i its INC Of min PLAT Of
MIAMI 1010116 UC?IOM 8, a s.iMaa to the plat thereof,
as r.. rdsd is Plat look 43 at Wags N of the PvIILc
lis.vda of Bede Comte, Made.
PPOPERTY
T Is. 1�
SKETCH NOT VALID
UNLESS IMPRINTED
WITH AM EMBOSSED
SEAL
(› ■PL- --
N
r
I hereby certify that the
attached sketch represents
a recent survey made under
my direction. and is true
and correct to the best of
my knowledge and belief.
and that there are no en-
croachments on said land
other than are shown acre-
- 1 5
1 MQIZ o Mt�aTS
c41 lu]KJ. .J r.- ,•.• DAT
Fla. Seq. Snrr.yor Mo. 21114 l • 1 ? • 7 •i
ur
0
Member of "Florida Society of Professional Land Surveyors"
f
ar: Ir.tr Twat, 100 0.i. U lit., Miami Shores, Fla.
30 ,
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P0
6 '
Yl
L.C?G ION
P► Pt:
FRANK MAKOWSKI & ASSOC. MC.
LANG SURVEYORS
P O Box 561081 K[tiOAl i Si.'
MIAMI F► nwip* 1 I'.t
ISCALE
" 7 Z. 0 I DOAWN P. sY j1,-ZO