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Owner of
Building
Architect
Contractor
or fader 1 : :#
lie : ' Lot
D iption
Address of
Building
This permit is granted to the contr
tion herefor in strict compliance with all ctrd
plans, drawings, statements or specifications t1
at any time if the work is Dot done in compliance
permit is granted is the understandin: that the co
regulations pertaining to the work ca
sibility for work done by his agents,
In consideration of Ole ;swan
pertaining thereto and in strict eoof
In accepting this permit I assuitte r
• .
CONt
Isit 90'01
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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.
Owner's Name and Address... _••,--.1.
Regitered Architect and/or Engineer
Name and address of licensed contractor.. titil
•
Location and legal description of lot to be built on:
Lot_ Block
Street and Number where work is to be done
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Chairman
Member
Member
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date_
PLANNING
Subdivision
73.7 ,
Date
No
/I A
Street__
Read, Sworn to and Subscribed before me.
Permit No
Disapproved____p 0 . e__
Notary Public, State of Florida
(Signed) .- (547.1....-e My _
uilfling Insp ctor Commission Expires_
DATE
Member
Member
Member
.Date Disapproved
19‘,
State work to be done and purpose of buNing (by floors)
/yr
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ _ Amount of Permit $
Zone cubage required _Plan Cubage__
Distance to next nearest building._ Size of Building Lot
Maximum live load to be borne by each floor__
I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit dot hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act. being Section 5968, 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 subcontractor , on work to be pe formed under this
permit, as are licensed by Miami Shores Village.
Cr" •-■
Remarks._ _ _____ (Signed) -if
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aAnowledgments, 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 stad are true.
to me well known,
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 51.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
P' s