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MECHANICAL PERMITa /1 4 0 a6, Yet Application is hereby mode for tlae approval of the detailed statement or 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, 1'1(1ri6. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and 111 rules and regulations of the iir''1ding Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifica4 ns must be kept at building during progreu of the work. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor. .14t t fi 1-1 L.�!) Lif llf Location and legal description of lot to be built on: � 0 �p Q Lot i Block Subdivision.�j :�u _ .L,�kf h._...._..L. 9 . /.. / . Street and Number where work is to be done... l i� . „.„ �. �� 1 „ Sj I / '��. State work to be done and purpose of bull in g ,(by floors Z1e / /2,.. „.. „CGYid.r.„ a....1.L';L „._. _°_ /0 /(2 e v - 5 l e' »:c7 / /� , '1T `” 'Cf:' Y r ' 1--h ............... :ads:= y g. 7 - /%a ,oe, - ' pc- DS f4S awa v c✓i r) .,4 76/0 5 L/- /44.41 � and for no other purpose. New Bui!ding Remodeling Addition Repairs No. of Stories _ To be constructed of Kind of foundation Covering Estimated Total cost of improvements $... - Op - 4 0 Amount of Permit s. 61 °, _.. Zone cubage required .„. „._„ „....Plan Cubage Distance .to next ne.uest building Size of Building Lot 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 be sent to.._ = ............ A fi°7 . - 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 59G6, Co r iled General Laws of n • a, ennanrnt Supplement, anti has complied with the provisions thereof, and will require similar compliance . n all contractors • sub-rnn ctors employed by him in the work to be performed under this permit; and will post or cause to be post inspection on t e site of t. wor uch public notice or notices as arc required by the Act. The undersigned agrees to employ only s bcon ors, on • k be f ormed under this permit, as are licensed by Miami Shores Village. Remarks STATE OF FLORIDA, COUNTY OF DADE. APPLICATION FOR l tdir4E t PERMIT 1..{ Fcl- i.t,71cAL ss. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 0,6\/1,D c 2.av and who, being by me first duly sworn, upon oath deposes and says that he is the.. ..e of the above described construction, that he has carefully read the foregoing application, therein by him stated are t( Permit No..„ . Date. . 1 q Disapproved at (Signed) Building Inspector NUTE: A charge of $1.00 will be made for the PI.tnnir.g Board. A rc•impcction fee of $1.00 will be charged materials anti /or workmanship. Chairman Member Member — - - ._ ...._..... Council Approved Date r6 9333 Date-- . 1. ....._ No. „I I © .._... Street._.V.:.E • 1 D 5 -t„ f:tt ft .•••f.f•!ffttfttffttt.! r1 3i FL 4,61E44 CGS Oo 2.o$4- - Read, Sworn to and Sub and that Notary Public, State My Commission Expires Before me, the pndersigned aut a notary public, duly authorized to administer oaths and take acknowledgments. personally ap- peared f / sl12. O._. il. Celve me well - -- he did sign the same, and at 511 facts Ir PLANNING BOARD _.._......DATE Member . Membcr „._..._ „_ Member Disapproved Date making corrections or changes to this application after approval has heen obtained from when such re- inspection is made necessary by Improper notice for inspection or faulty