860 NE 98 StL1 —
i G
MIA■
BUILDI
APPLI CAT]
Application is hereby made for the approval of
ing or other structure herein described. This applica
Shores Village, Florida, and all provisions of the La
regulations of the Building Division of Miami Shores
plans and specifications must be kept at building du
Owners Name and Address ... 1111.h.4 . viY..4 :.....s!!�N.
Registered Architect and /or Engineer ..... .(!h• (1. �� .70 Name and address of licensed contractor ..... I-
Location and legal description of lot to be built on:
Lot 4'- E t 3 s' ' ¢ � Block 1 3
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Chairman -
\lcrr,ber
Member ...... _....__......_
Council Approved Date
S ORES VVLLA E
G INSPECTION DEPARTMENT
N1 FO
r
— No Street _ g�RQ.H. f -9 > 5 t
L
Co A P `off 5 hl ...�; / / s 5 4-
BUILDING PERMIT
detailed statement of the plans and specifications herewith submitted for the build -
n is made in compliance and conformity with the Building Ordinance of Miami
of the State of Florida, all ordinances of Miami Shores Village and all rules and
illage shall be complied with, whether herein specified or not. A copy of approved
progress of the work.
Subdivision
,sc. f Ford
Street and Number where work is to be done
State work to be done and purpose of building (by floors) / N 1....... , , d 0
/ and for no other purpose.
New Building Remodeling Additio .V Repairs No. of Stories
S d c ,t' �' ¢�' Roof Covering ¢ y _
To be constructed of .... / . � Kind of foundation. . ..... f g --- •TP• -� -•- • -• 74'
Estimated Total cost of improvements $ 1.3:9 ®B 7 . Amount of Permit $,.
Zone cubage required / -r .Plan Cubage
V 4 r
Distance to next nearest budding Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications
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, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe 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 subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks._._ (Signed) 272
(30 z s
i7 - BI Z.
3 17/ r ,4 tvi r l
or said building. All notices with reference to the building and its construction may
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 25 6 Read, Sworn to and Subscribed before me.
Disapproved // ,. °'s ._
Date._
f /
(Signed) ----.-________:\...
^�_� �
'Buildi Inspector , My Commission Expires
PLQ�ININC BOARD DATE
Notary Public, State of Florida
Member
Member
Member
Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re fce of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
to me well known,
has been obtained from
for inspe turn or faulty
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