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Name nd address of licensed contractor.
Estimated ;tat cost of improvements $ -_
Zone cubage required_
Disapproved Date
(Signed) i c % 1���
Chahinan _..
Member
Member
Council Approved
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det, sled statemen• of the plans and specifications herewith submitted for the build-
ing or o h '. ructure her described This ri licatic is made in compliance and con o'm ty with the Building Ordinance of Mia u
Shores Village, or da, and all pro isions of the Laws cf the State cf Ilk-rid. all o d nances of Mi ni Shores Village' and all rules and
regua' ion.- of the Building Div.. i of .tam Sho. iilage F '1 e o.,pl-ed with, whether herein specified or not. A copy of approved
plans and specificati .nQ must be kej at bur'd:ng durin progresj of tl.e wcrk.
Owner' Name and Address.__ -_ ___
Registered Architect and /or Engineer._. _ /4)4-
New Building. / . _ Rernodeling ____ _ ._ Addition__.. Repairs. .
To be constructed of CRS Kind of oundation — ., eA (?` ...<
s9 (ifi a -- _ .__. __ ount cf Permit $.
_Plan Cubage____. ' l-
Location and legal description of lot to be built on:
Lot >! _ Block.__ ____ / Subdivision - - -f
Street and Number where work is to be done 1 '
State work to be done and purpose of building (by floors)_ —'--
■
e of Building Lot
spector My Commission Expires
. and for no other purpose.
No. of Stories - /
of Coring . L
Distance to next nearest building__ ..
Maximum live load to be borne by each floor _
hereby submit all the plans and specirications for said building. All notices with reference to the building and its construction may
be sent to - - -- -- - - --
The unde signed appli ant for th s building permit does hereby certify fat he understands and accepts h =s .bligations as an employer
of 1- bor under he Florida Workmen's Compensation Act being S Lion 5966 Col p led Gen al Laws of Florida P r anon. S ip ili nent,
and h s compl ed w'th the prov' ions thereof, and will require s nrilar comp lance from •ontrac•tors or sub contractors emplo -ed by hint
in the wo,k to be p rf •me under th s pern it and ill post or cause to be posted f msp ction on the site -of the work su :h public note e
or Notices as are requir d Iy the Act. The u. 4,r ign d agrees to employ only suc abc•Q • ctors, on J v• k to be perform cl . der this
permit as are licensed by M am. Shores \ i1:: ge.
Remarks- (S;g-ied )
r
Notary Public State of Florida
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,.nd take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first d: ly sworn, upon oath depores and says that he is the __ _.
of th abov de c ibed ,struction t. ; h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie.
� Permit No. 56 / Date._ I r ` C Read, Sworn to and Subscribed before me.
PLANNING BOARD __.DATE
Member - -- -.
Member
Member
Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application , .ft , r approval h bee n obtained from
the Planr ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is ma: le necessary by improper notice fc r inspe t•or or fa. , ty
materials and /or workmanship.
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