PLANS•
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 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 ________ / r__t / �1
Registered Architect and /or Engineer _______________! =y °Z 4
STATE OF FLORIDA,
COUNTY OF DADE. j ss
peared
MIAMI SHOR VILLAGE
BUILDING INSPECTION DEPARTMENT
/1 h
Date
Name and address of licensed contractor___ a_;4 rI t_ _; ir
Location and legal description of lot to be bu on: • f •
T Block /7 Subdivision_______ /!', "'may
Lot
Street and Number where work to be. done________ _° �___ ���__
- / — - � r T 3
State work to be done and purpose of building (bk floors)____.
, 3,
1
No.- Street
T- —
New Building 3 R emodeling____— Additign- _�______.__ __ -__. Repairs No. of Stotie
To be constructed of (** T ,- Kind of = ' . Roof overin 77 )
Estimated Total cost of improve $ __ J��_ J ') n) ,__Amount of Permit $ - .__.__ •
Zone cubage required -- �!�_ _'�z F
-- - -- _------ - - - - -- -flan Cubage_ - - - - -- 4 -- ._____ -_
Distance to next nearest building r1_r') Size of Building Lot :'
Maximum live load to be borne by each floor___— *.41
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
Read, Sworn to and Subscribed before'me.
Notary Public, State of Florida
and for no other purpose.
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; 5968, 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 Man
in the work to be performed -under this permit; and will post or;vause to be posted for inspection on the site of th work ch public notice
or notices as are required by The Act. The undersigned agrees to s
employ only such subcontractor} work to Se perfor ed under this
permit, as are licensed by Miami Shores Village. t
Building Inspector My Commission Expires
Remarks , (Signed) -- ;
Before rne, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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. Date
Disapproved Date
(Signed)
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 obtaihed 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 faulty
materials and /or workmanship.
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