28 NE 98 StBt. LDING INSPECTION DEPARTMENT
M I SHORES VILLAGE
k
..r,
Application is hereby made for the approval of the detailed statement of 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
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.
APPLICATION FOR BUILDING PERMIT
Owner's Name and Address _ _ °"
Registered Architect and /or Engineer ? $ 'r
Name and address of licensed contractor_
Location 9,ifl legal description of lot to be built ori:
Lot 4' / / Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Zone cubage required !__* G
Distance to next nearest building D
Maximum live load to be borne by each floor
Subdivision____'_ f
1 ,1 „ geZeZ ,v..
To be constructed of A-
°....
New Building V Modeling Add ipgn Repairs No. of Sri of undation YPJ
� -er= +� Roof Covering
Estimated Total cost of improvements $ / Amount of Permit $______ _Y
I hereby submit all the plans and specifications fo; said building. All notices with refer ce to the building and its construction may
be sent to' ?. ' – � – – r – – - - - -- 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 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspec ion on the site of the work suc public notice
or notices as are required by the Act. The undersigned agrees to employ only such su.jjors, on work to e >perf9rTned under this
permit, as are licensed by Miami Shores Village. -- o
Remarks (Signed) 0- / "_:
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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,
therein by him stated are true.
Permit No Dat I q y Read, Sworn to and Subscribed before me.
Disapproved ► ate
( Signed) -- - - --
� • Building Inspector
_Plan Cubage__
Date__
No
9� 85o
/i3
S)ze of Building Lot
Notary Public, State of Florida
My Commission Expires_
PLANNING BOARD DATE
Chairman Member
Member Member _
Member Member
Council Approved Date Disapproved
and for no other purpose.
and tha all f acts
_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 Planning Board.
A re- inspection 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.