WINDOWSApplication is hereby made for the approval of the detailed statement ur me 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
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.
/��// //��
Date..—...—. 2 t 4 19
Owner's Name and Address ...... /. • t ' ' V f4 i�. _ No..,l ._. . Street 2.?. 7*4—
Registered Architect and /or Engineer
Name and address of licensed contactor
Location and legal des iption o§ tot to be built on:
Lot.E ..i?- 4- /+: Block
Street and Number where work is to be done
State work to be done aa d purpose of buildi
040- t 1 4/We40 - r
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Building Inspector
Subdivision. .,t <eZL'= (re $ ...._. ILO v / 6 / 16 7
G 9 » _.
ng (by floors). e�l!�
R$ rNelufnlo6teJ4 /NJ ..v
1!....1 99 • :9"“VItt74nv !!It
-41 fi,GUC--y A L a t`4.17 t£
and for no other purpose.
Ncw Building Remodeling Addition Repairs , -- -- No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ a1•S•O. 00
Amount of Permit $ 31 1`
Zone cubage required .Plan Cubage
Distance .to next nearest building Size of Building Lot
Mfaxiunum 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 permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act. being Section 5 Compiled General Laws of Florida, Permanent Supplement,
and has complied NI ith the rovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performe 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 are required by the Act. The undersigned agrees to ernploy only such subcont actors, work to be under this
permit. as are licensed by Miami Shores Village.
Remarks... (Signed)
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally ap-
peared
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 construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are jrue. .
Permit No.—ND _ Date Read, Sworn to and Subscribed before me.
1/1)41,
Disapproved tip -: �[� Y Date
(Signed)
Notary Public, State of Florida
My Commission Expires _. „.
PLANNING BOARD DATE •
Ciiair:nan Member •
Member Member
\lcmbcr .. .. _....._....... Member
Council Approved Date Disapproved Date
NOTE: A charge of Sl.00 will be made for making corrections or changes to this application after approval has been obtained from
the 1'I.innir.g Board.
A rein.pec•tion fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.