MECHANICALBUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby umdc for the approval of the detailed statement in use plans and specifications herewith submitted for the build •
inc or other structure herein described. This application Is made in compliance and conformity with the Building Urdinance of Miami
Shores Village. Florida. mut all provisions of the Laws of the State of Florida. all ordinances of Miami Shores Village and 111 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.
NI 00
Data • ,I9W
No 11 9 ct Strevt---q-8ct
Owner's Name. and Address E"
........
Name and address of licensed contractor Pes i cve..yri-/A L. A i .2... c .., 0,050 &IP /, C-
Registered Architect and/or Engineer a...7_
r. p
Localion nd lc alycles tton t to be buil 33/77-
Y - ii ° iE-gotiO r
work to done and purpose of building (by floors) 09 tY
_ itfc sfr
Lii_TIA.. 1--EiJ e •
Li() s i 4 -St k apii,.. C81/3-57 Adz 1.10,toni an
d for other
..
Ncw BuildinSEER 11-Reetql ..e.M..71rtaition..•....*••••• ..... ao.....■ Repairi................•......--. No. of Stories..._. • • 0. ••••••••••••••■••••■
To be constructed of _.... ......... -..-.. Kind of foundation-- *MEM ••■•••• ••■• •••••■••• • WOW.... Roof Covering-_____•.... •• •_•. •• .
,
Estimated Total cost of im . ,D C provements ., . `---.—Amount of Permit t - 111 5B
Street and Number where work is to be done
Zone cubage required
Distance .to next nearest building
Maximum live load to be borne by each floor . •
I hereby submit all the plans a for said building. All notices with--reference building and its construction
be sent to.. ....... ...-.-.--..-... .... — —
The mulersigned applicant for this building permit does hereby ern-61y that he understands and accepts his obligations as an employer
of labor under the Florida Woikiiteri'S CoriMensation being S966, Compiled Ceneral-Laws-of-Florida, Pennam•nt-Soppiement,
and has complied with the provisions thereof, and will s br compliance-from sub-contractors employed by him-
in the work to bc performed tinder this permit; and will post or cause to be posted for inspectio an the site of the work ch public notice
or notices 1S are required by the Act. The undersigned agrees to employ only such in. • • actors, on wo to • • ed under this
--4'
- permit, as are licensed by Miami Shores Village,
---
(Signed LI4IPr -
Relks — ---
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally ap-
peared —
and who, being by mc first duly sworn. upon oath_depose.s and says that he is the • •- • •
..
1- .. 7.m_ —77-47: _ .. .•..
of the above described construction. that lielias cntefullyieadthe foregoing applietar.W rfigtP andlhat-all:fa
therein by him stat are E. • ' - . • - *. r4-.-Cie.fet....1d'--179t.:.775,7.!ffit-1984t7--'•-------• -*---'-•'-',-- ---.- -•- •-•-•
Swg "t2 .
Permit No Date. Read,
hru rty -
— '7 • s?...;',-E.Z. . :—: • ''
Cliairinan
Member
Member ..
Council Approved _
MIAMI SHORES VILLAGE
Size of Building Lot
Date.—
Disapproved
(Signed) .--- .
Building nspector
Cubage
PLANNINC BOARD
to me well known,
•
ary Public. State of Florida
My Commiuion Expires
----DATE_ .
Member ••■•••■•■••■•••••••........
Member........—
Member
Date Disapproved .Date
NU71::: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the I'I..nnir.,. nom&
A re fce of 11.00 will bc charged when such re-inspection is nude necessary by improper notice for inspevtion or faulty
materiali. anuior workinanship.