5 NE 99 StRegistered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot_S 3 `� 1 Block
Street and Number where work is to be done
State work to be done
New Building
To be constructed of CO S Kind of foundation
�F ° v
Estimated Total cost of improvements $
Zone cubage required f S 0
Distance to next nearest building LO
Disapproved
( Signed)
Remo uling Attlit trrr∎
1 Date 1- i r _z 1
Chairman
Member
Member
Council Approved Date
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 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.
Ju 1�
Owner's Name and Address J C K U / C .P V /S / A✓ No. E Street
7' a ,l1' i r
�sr_nri (t — 13 u I r_ 0 g v$ _.1_✓, :� 7 6 I S T
Date
Subdivision_ -._ __ /__ !`_'t _I ____S/_�E c.)_tt GS Se No . / • 0/7 d
r.
and purpose of building (by floors). FR-Re r .l -ti, L �' � .f!-_ IC14 piz-" A`
and for no other purpose.
Repeirem. No. of Stories
Roof Covering t i
2 n L..
Amount of Permit $
n
_Plan Cubage 5 " coLv r.
Size of Building Lot / )(__/_.310
Maximum live load to be borne by each floor_ 40
I hereby sub it all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to _ v1 -� `� • -5� :''v s y2/44' 'k SI /It 4 /H 1
The undersigned applicant for this building permit does hereby certify that he understands and accepts
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compile. "en. al La
and has complied with the provisions thereof, and will require similar compliance fro al co g acto
in the work to be performed under this permit; and will post or cause to be posted
or notices as are required by the Act. The undersigned agrees to employ only such
permit, as are licensed by Miami Shores Village.
Remarks (Signe
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, and that all facts
therein by him�i}�!
are�
Permit Nou
Read, Sworn to and Subscribed before me.
obligations as an employer
a, Permanent Supplement,
actors employed by him
e work such public notice
be performed u
ate
Notary Public, State of Florida
g Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved 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.
,I9S
7t Sr