MECHANICALOwner's Name and Address
APPLICATION FOR BUILDING PERMIT
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.
P4-4- ?5 -6212-0°
P4 6 P 4E44 ss �°-
Registered Architect and/or Engineer
Name and address of licensed contractor
Remodeling
New Building
To be constructed of Kind of foundation
Estimated Total cost of improvements S
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
i/
Addition Repairs
Amount of Permit S
Date / — L 191L_7
No. At ? O Street V59$7
/tea
Location and legal description of lot to be built on:
Lot 3 Block /79 Subdivision my, / f I� 3gt0 s le
eiga
Street and Number where work is to be done /17 G y Lcs/
State work to be done and purpose of building by floors), state exterior colors (submit samples)
�i' CC/
and for no other purpose.
No. of Stories
Roof covering
Zone cubage required Plan Cubage
Distance to next nearest building
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 undersigne. : • ees to employ only such s .contractors. on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA
COUNTY OF DADE.
} SS.
Before me. the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 for • oing application, and that he did sign the same. and that all facts therein by him stated are true.
Permit No.
Disapproved
(Signed)
Date 1 1
Date
Size of Building Lot
Read. Sworn to and Subscribed before me.
Notary Public, State of Florida
to me well known.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 and,or workmanship.
Estimated Total cost of improvements $
Permit No.._.
Disapproved
(Signed)
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby uindc for the approval of the detailed statement us one 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.
Date...&.= .L .....r..__..._.__......_.__..._ ,194! r
Owner's Name and Address ......P4.ILJ.P........L°tlii"Sa. ^^ _. No. Street ?.t1 /
Registered Architect and /or Engineer -- ' `p //,�.,, y ._\ . ..•••....:..:nm...••.- ..•a,:
Name and address of licensed contractor.. is` _ ow l '� ._. Ale. .... J'' u.
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done J /..-2.‘ A ' 11.227. __ . - .._.. ...._._ .�..
State wor to be done and purpose of budding (by floors).... K � � 'F . �:U_!L__ .5.e
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation Roof47ring
i
Amount of Permit 5�..
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,
anti has complied kith 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 arc required by the Act. The undersigned agrees to employ only sMcls—st►1?contractors, on � to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed)
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
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 ale true.
Date J 1L
Date
Chairman
Member
Member __....__..__._..._. ....._.......
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning lio.trd.
A rc•inNpection fee of S1.00 will be charged
materials and /or workmanship.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved
or changes to this application after approval
to me well known,
Date
has been obtained from
when such re-Inspection is made necessary by Improper notice for inspection or faulty