Driveway & sidewalk.Street and Number where work is to be done
Disapprove d . �. -
(Signed) G v
Building In pector
Chairman
Member
Member ......
Council Approved
(.0 ,L Y
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 Miaml
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miaml Shores Village and all rules and
regulations of the Building Division of Miami Shores Villap 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.
� 8 treet._.. ._._ �� ...
Owners Name and Address .... EA 4C// M' / 7"r /tom
Registered Architect and /or Engineer CD
Name and address of licensed contractor u14 /7e3 // . / 1Z a3 , I / .3 7 41 °e: /'744-„
Location and legal description of lot to be built on:
Lot Block Subdivision
State work to be done and purpose of building (by floors) r ve- e /e6-7-e .9e� ,'Z' 4 " r 6F IL /r C / Ty
._: :1.00WAc� feF ;"C A.- RE ' 4:7, e,& T C /Tt- 5?De "4c,t- ; 4-9OO C0 TrCe/c7
.- /PO " c x' 4 Ceni • ()Rive itrevAaRceD w✓ 1 97y 6 'tip - /O /O i e'er.. for no other purpose.
New Building Remodeling Addition
To be constructed of Kind of founcation
Estimated Total cost of improvements $ Amount of Permit $.
Zone cubage required _Plan Cubage v
Distance to next nearest building Size of Building Lot 7.5 /As-
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference
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 5966, Compiled General Laws of Florida, Pennanent 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 inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ubcontractors, on work be performed under this
pennit, as are licensed by Miami Shores Village. j
Remarks (Sign
STATE OF FLORIDA, I
COUNTY OF DADE. 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 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.
ate.
PLANNING BOARD DATE
NOTE: A charge of $1.00 will be made for making corrections
the Planning hoard.
A re- inspection fee of 31.00 will be charged
materials anti /or workmanship.
Member
Member
Member
Date Disapproved
Repairs No. of Stories
Roof Covering
J �,ti
)ix
Notary Public, State of Florida
My Commission Expires
or changes to this application after approval
to the building and its construction may
to me well known,
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
,....ay r • 41.:'yp y . l:e' <. e_'t. + .r'3G- .;.RX,i...: -:.. .+
C
i ' /
f .77Z7Rr
■