MECHANICALApplication is hereby made for the approval of the detailed state...ent or use plans and specifications herewith submitted for the build
inc or othef structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Villa,, 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.
,[� /� 1G9
Owner's Name and Address / /V 6(1 /e� — No. Street -O��� -
Registered Architect and /or Engineer
Name and address of licensed contractor..
Locatioq _and legal dcription of lot to be built on:
Block /a/ Subdivision E " � 4
done '0 /(/'_ _.. _ `
Street and Number where. work is to be
State work to be doe and purpose of
1- 4- ....... 4/5
STATE OF FLORIDA, I
COUNTY OF DADE. Ss.
APPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
ilding (by floors) ;/
Building Inspector
Addition Repairs
. ,1/ fp s
1
Notary Public, State of Florida
My Commission Expires
s
A?! / G / 7'
d9,1/ �e Z€ s '
and for no other purpose.
New Building Remodeling
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ ..- . ./J -.r/ 0 0 . 60 Amount of Permit S.
Zone cubage required Plan Cubage
Distance .to next nearest building Size of Building Lot _
No. of Stories _
Mfaxiunum 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 ;ts an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
anti 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 site of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, op rk to be performe under this
permit, as are licensed by Miami Shores Village.
Remarks
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 stated are e.
Permit No.........* b ,Date 4 Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
PLANNING BOARD DATE
Chairman Member
Member Member
Member .. .. _.._..__....._..._. _ .._._....... Member ...._
Council Approved Date Disapproved Date
NOTE: A charge of S1.00 will be made for making corrections or changes to this application niter approval has been obtained from
the 1'Iannir..; Board.
A re- inspection fce of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspectinn of faulty
materials and /or workmanship.