WINDOWSPermit No.___E 3d
Disapproved
(Signed)
MIAMI SHO
f- Dle a
Building Insp- or
Date 1-_7 - �o
ES I L L G E
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR aUILDINl3 PE
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.
nc � Owner's Name and Address 1` C �1 C /l! 5 e 7te
No
Registered Architect and /or Engineer
Name and address of licensed contractor__
Location and legal description of lot to be built on:
Lot Block Subdivision
8 7 3 Az F.
F-�
MIT
� , 19
Street , ,_a
4 C � e7C) 4/
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Street and Number where work is to be done
St e work to be done and purpose of building (by floors) i�
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind- founda,i� Roof Covering
Estimated Total cost of improvements $ b 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 plan and specifications for said building. All notices ith reference to th ilding onstruetion r
/ ,cl i_�- / � C _ f 4L �' - _ ,7 - -- - - - -- 4'1' �
be sent to`� r-- ` -
._
The undersigned applicant for thi u ilding pennit 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 hint
in the work to be performed under this permit; and will post or cause to be posted for ' spection on the site of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such suLontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signe ' ' ' - '
STATE OF FLORIDA,
COUNTY OF DADE. j 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 stated are true.
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or chmges 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.