BUILDING (7)•
Application is hereby mode for the approval of the detailed statement in ene plans and specifications herewith submitted for the build
in 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. /,.../3e9
• Owner's Name and Address 3d2lai ei-eiv �- e / )- e,..„,:%`' -& _. No.... ..__ Street 4) _ /i- h 4
Registered Architect and /or Engineer
`' e a dad cc f 1 cnsed contractor. i� et�r r
J/ e7 , , i ./o> a) /pub ,ve � o X le r v . -e,eo e/5 /,1 - 0,e i, - 1/ / &'4f s
New Bui!ding
To be constructed of
Disapproved .....
(Signed )
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT 1/4. 177 - W -5 7
APPLICATION FOR BUILDING PERMIT
ASS 1,
Bate.
Building Inspector
be sent to.. ®. � o � y'a• � �'
Rern.uks..._ (Signed)
oration and legal c scription of lot to be built on: Jaa7? 0 r: /w 4 ea k - 7 d , /u / T �f er �'srj
Block /a 9 Subdivision i /U 7 .'e G 'L
Street and Number where work is to be done ,5 .&i?.v 16 S°/ kce
_ Cvui
State work to be done and purpose of building (by floors) to .. pot!i? _ , i{l �%r le cje .re.F
E
and for no other purpose.
Remodeling Addition Repairs No. of Stories
Kind of foundation Roof revering
O
Estimatcd Total cost of improvements S off' Amount of Permit s.` 7p _
Zone cubage required plan Cubage _
Distance •to next nearest building.. /J e T Size of Building Lot ...... '2. X .. ''2-f
- .. / .
Maximum 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
The un,lcrsigr.ed applicant for ibis 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 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 aubcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
.Sl
Notary Public. State of Florida
My Commission Expires _. ».» _...._... ».._.__
STATE OF FLORIDA,
COUNTY OF DADE. 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 we. .
Permit No...—.24 Date \ (0/ Read. Sworn to and Subscribed before me.
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 after approval has hecn obtained from
the I'lannir.;; Board.
A rc- inspection fce of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
/PIPE 'WA/P
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