MECHANICALSTATE OF FLORIDA,
COUNTY OF DADS. ss' IL)" 927
Disapproved Disapproved ........
(Signed )
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement 01 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
Shorts 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�`.�_ ,19.
Owner's Dame and Address .... e 11/4) . Street C .....�T_ —.
Registered Architect and /or Engineer . .... ...••..... . ... nn : rw..,•........ v,.•...
Name and address of licensed contractor DE kiaff
Location and Legal description of lot to be built on: -,�- . /
Lot / Block / S bdivision tiP .. /2 J O! 0094
Street and Number where work is to be done... 1.0.5' e.Pi
State work to be done and purpose of building (by floo, a)....>nlG�C Qv.._�7r 15r7ti s!r- $ g 7L_. £ Lj. fl _ 6 IL:
37010 .... ._ (� �7'.. s vs ot .co . _..3 � S.(Q elk Viler 4O• 0a6;
Sea- ` 1r.,!•- U...1.i�} and for no other purpose. ..._....._..--- ... -.__
1
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ c�Q Amount of Permit 14 3.t. / 14 3.t. / y
Zone cubage required _Plan Cubage r.
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 per:nit does hereby certify that he understands and accepts his obligations as an employer
of Libor under the Florida Workmen's Compensation Act, being Section 5966. Compiled General Laws of Florida, Permanent Supplement,
and has complied %sith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to • c 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 •uir the Act. e undersigned agrees to employ only such stfbepntractors, on work to he performed under this
pcnnit, as are lieen' •• iami Sho s Village.
Remarks..._ � •�:. :•�- -, - -- -- --
(Signed)
Before me, the undersigned authority. a notary public,'duly authorizcd to administer oaths and take acknowledgments, personally ap-
peared
to
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,
therein by him stated are e.
Permit Wit Date l *J4 Read, Sworn to and Subscribed before me.
Date.
nd that ; e did sig((j the same, and that all facts
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member _..._
NI ember .. .. _.....__....._..._._...._.._.._ 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 obtained from
the I'Linnir.g Board.
A rc•in.pt•t•tion 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.
/ - 7 n r\ j (