53 NE 98 StApplication 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 regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy 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
8
Distance to next nearest building _ �'"'
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No Date_
Disapproved __— _— _ —��__ Date
(Signed)
Chairman _
Member
Member d
Council Approve
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
INSPECTION
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
INSPECTION
A FOR BUILDING PERT
PPLICATION IT
Kind of foundat�n__
f
Date__
No.
Locatio n le d ption of lot to b�ibuilt on: 9 Lot 1� Block __ _ _ Sub ivision ''�' /� ''
Street and Number where work is to be done-, qr
State work to be done and purpose of buildinl
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Date Disapproved
Plan Cubage
Size of Building Lot / 'J /1'""
Read, Sworn to and Subscribed before me.
', t.
Notary Public, State of Florida
_and for no other purpose.
___
New Building_ "'�
�"• Remodeling__" Addition Repairs _____
No. of Stories______
rEl
Roof Covering
To be construct
Estimated Total cost of impr of Permit $_�
vements $_� / d `� ' ` -
tt _ 3�__�— Amount r
Zone tuba a required % � C Q'"ros ^ pl 014
Street..
Maximum live load to be borne by each floor
I hereby s it a1�the lans and specifi tions for said b i1 ding. All noti vithrefference to the building and its construction may
be sent to . • ,/1r • 05 ) G 7 'i' ��1 ' __!__
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 insp ion on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ma y.: o'ctors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signe
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known,
, that he has careful read the regoing application, a and who, being by me first duly sworn, upon oath deposes and says that he is the `- I
of the above described construction
therein by him ;t;te re true.
nate
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.
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