FENCEAPPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ur one plans and specifications herewith submitted for the build •
inc 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 iuilding 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 " s
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is t be done
Subdivision
$q A)E. g Sf, x
State work to be done and purpose of budding (by floors).. ._L Q ..i O _ .�.f!_. ! .�.1�w.k e.
Disapproved - 1.,1 Date..
(Signed)
MIAMI SHORES VILLAGE
o o Date... ��. . i...� _..__ .......__ ,19..
Q SS eJ`�. ! ?.'ts� _ No... ..� 9.._.. street
Building Inspector
BUILDING INSPECTION DEPARTMENT
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation R000vering
Estimated Total cost of improvements $ 2 -4 1 6.1 e (leg Amount of Permit $. ...�Ql...
Zone cubage required � .Plan Cubage
Distance .to next nearest building Size of Building Lot
Nfaxunum 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 Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the rovisions 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 cruse to be posted for inspection on the site of the work such public notice
or noticcs as are required by the Act. The undersigned agrees to employ only su &subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. I ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 carefull read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.. J
Permit No.._ S1 Date 41V Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member ...._
Council Approved Date Disapproved
tI :.T 1*.•••... -.11 "MT !Mt. tt...lt.tS l.tl
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval has
tl�e I'I.innirng Board.
A re-inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for
materials anti /or workmanship.
to me well known,
Date
been obtained from
inspection or faulty