PAINTApplication 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.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Loteiliil.14 / f
Street and Number where work is to be done
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Block
PO/ -t
0.44/ `
Disapproved _k\ a\ _ (f Date
Subdivision V€/4 // ✓ , - ' e1 o /20
/ 21/t A. 99 .rte
(Signed)
Date 7/ 19 ,
No. ( ` 4 t Street / f rJ /f /k
and for no other purpose.
New Building Remodeling - Addition Repairs No of Stories
To be constructed of / Kind of foundation Ro Covering
Estimated Total cost of improvements $ 6 4o Amount of Permit S 31t D
Zone cubage required Plan Cubage
Size of Building Lot
with reference to the building and its construction may be sent to
mderstands and accepts his obligatons as an employer of Labor under the Florida Workmen's
nanent Supplement, and has complied with the provisions thereof, and will require similar
rk to be performed under this permit; and will post or cause to be posted for inspection
t. The undersigned agrees to employ only such subcontractors, on work to be performed
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
to me well known.
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described cg that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true.
Permit' No. ` �/ Date Read, Sworn to and Subscribed before me.
Notary Public. State of Florida
(Signed) " w• 1 ' — "
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.