BUILDING (5)Application is hereby made for the approval of the detailed statement us one plans and specifications herewith submitted for the build
Inc or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Slioees Village, Florida. anti all provisions of the Laws of the State of Florida. all ordinances of Miami Shores Village and ill rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
Duns and specifications must be kept at building during progress of the work.
Date ID-- Lc) 19 /
No. `7� Strre� 1J �7 " $• of -'`
Owners Name and Address -7 -S
Registered Architect and /or En;incer )'%4/
4", / 1 �
"
Name and address of licensed contractor_. + 1 _' /J
Disapproved
(Sinned) .._.._._
APPLICATION FOR BUILDING' PERMIT
MIAMI SHORES VILLAGE /ko- f---
BUILDING INSPECTION DEPARTMENT
Locati%and foal d • eription of lot to be bt Subdivision u / ilt pn: ,_� � f � ��
Lot_ t? '� -� Block.__/s2
�— _ - -.. b� — (
Street and Number where work is to be done 5 S CA �� P`��T l - r-1 J �c1.:. �'L.
7: Z Y �Zt1Za�� 67 " 5 C,
ate work to be ne an / d2urpose of building (by floors),
SS.
Date
Building Inspector
New Building ....__...._
To be constructed of ._.... ._... Kind of foundation...._
Size of Building Lot
•
and for no other purpose.
No. of Stories......
____.._.__ Roo! C�,ovtring. ?Z,Z' _ S L•c
y5., Q °�s ° (' Amount of Permit Z f 4 ( -
Plan Cubage
Estimated Total cost of improvements S
Zone cubage required
Distance .to next nearest building
Maximum live load to be borne by each floor
- -- ---- I hereby submit all the plans and specifications for said building
be sent to.. _ _ •
T:^ 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. bring Section S'J66, Compiled General Laws of Florida. lennanent 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 the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Rem ks (Signed)
V
STATE OF FLORIDA.
COUNTY OF DADE.
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally ap-
peared
. All notices with reference to the building and its construction -may-
to me well known,
and who. being by me first duly sworn. upon oath deposes and says that he is t and that he did -sign the Barrie, and that all = fat4s�
of the above described construction, that has - carefully read the forego t g application, "
therein• by him stated are tpse..
Permit No 9 V 1 \ ° Date 'k1 k 1 Read. Sworn to and Subscribed before >s,e.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Chairman
Member
Member ..
Council Approved Date Disapproved ..___._.._ Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has hero obtained from
the PI..nnir... i:u. rd.
A re.iri.ti.•ction fee of S1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials anti/or workmanship.