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PAINTQ Name and address of licensed contractor Zone cubage required Distance to next nearest buildin Maximum live load to be borne I hereby submit all plans an The undersigned applicant for t Compensation Act, being Section compliance from all 'contractors 1 on the site of the work such pub under this permit. as are licensd. Remarks STATE OF FLORIDA COUNTY OF DADE. }SS. ifr/?rTf,Q din 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 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. f Rober W. ate AI 5itt1 19 " G Owner's Name and Address ! 2 2 3 NE L 9 , J t S ee-1 a m m 6 i7"' 1Qos 7 R4- Stree 3 /38 Registered Architect and /or Engineer 0unceAr Location and legal description of lot to be built on: �p ,�y� Lot ! Block SubdivisiorL ff / .424 J 1 / t7 oz9 � B f ®F/O�% a Street and Number where work is to be done / 2-23 N E c q >& S r ' e s — �i1 Q 4- J �" /-' d-a- 3313 ' `e 110State work to be done and purpose of building (by floors), state exterior colors (submit samples) pat-41 * ho u Se W 1 " q - SQJule. Colo -vs as b e rms — to / WIYIA 9 reu +v-; rn — s ee cv / m' s am p /es and for no other purpose. Remodeling Addition Repairs No. of Stories New Building To be constructed of Kind of foundation Roof Covering OEstimated Total cost of improvements s �f 50 o ' Bo notices with reference to the building and its construction may be sent to that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's L ida, Permanent Supplement, and has complied with the provisions thereof, and will require similar hh the work to be performed under this permit; and will post or cause to be posted for inspection {y the Act. The un rsigned agree to employ only such subcontractors, on work to be performed 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 foregoing :.plication, and that he did sign the same, and that all facts therein by him stated are true. � j Permit No. CIF / / q 7 Date `.) S Read, Sworn to and Subscribed before me. Disapproved Date Notary Public. State of Florida (Signed) Amount of Permit 8 i7 ' .5 Plan Cubage Size of Building Lot •(Signed) 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 825.00 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 825.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.