FENCEt �5
Ncw Building Remodeling
STATE OF FLORIDA, t .
COUNTY OF DADE. i ss.
Chairman
\Icrr,ber
Member ... _.....--- ...._..._.�...._
Council Approved Date
MIAMI SHORES VILLAGE
-- BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
APPlication is hereby uinde for the approval of the detailed statement ur inc 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 iuilding 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.
Date.. g
Owner's Name and Address Yti l- .�_...t . � � !S..r ... No. -11. /- 2 L1..... Street—A) Q
Registered Architect and /or Engineer
Name and address of licensed contractor ..lb h Jt..FoO(.r PA17
L dl t' flot t b built
5yf 1708 -7 S7
GJ P4-� iV44tf�
Location and + legal description
o c u► on: C a Q r
Lot l Block 4.7. Subdivision t v 9 � �° Se -•+
t
Street and Number where work is to be done l .. _ 4 6 Al..�r .. ) 4 6 7 ._..._..
State work to be done and purpose of building (by floors)
The undersigned applicant for this building permit does hereby certify that he under
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compil
and has complied with the provisions thereof, and will require similar compliance fr
in the work to be performed under this permit; and will post or cause to be posted
or notices as arc required by the Act. The undersigned agrees to employ only suc
pennit, as are licensed by Miami Shores Village.
Remarks (Signed
Disapproved .._._ r Date C. .--11 A
(Signed)
Building Inspector
PLANNING BOARD
Member
Member
Member
Disapproved
,,;,, , ,,, .
Addition Repairs No. of Stories
To be constructed of ..(i..PI./.!(, bind of foundation Roof Covering
Estimated Total cost of improvements $ CA. o 0 0 Amount of Permit 5,... .I. 00
Plan Cubage
Size of Building Lot....I ..J
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. All notices with reference to the building and its construction may
be sent toV421/41... e0(48 %C.... PtO . PATIO (`S t 7 0 t/ - '7 C 57 C...6.1 aCa l3
/� 0/1 .8.37 / $
nd accepts his obligatio
al Laws of Florida, Pen
'tractors or Sub -contrac
ection on the site gf the w
ntractors, on wor to be
and for no other purpose.
an employer
np dement,
yed by him
uhlic notice
under this
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally ap-
peared e 7- Llo.� �Wef
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the. lam.
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.
te .
Permit No.. ' / % N Date 3 1 f
V/ Read, Sworn to and Subscribed before me.
My Commission Expires
otary Public, State of Florida -
•
4UTARY PUBLIC SlAlt ..r t-LORIbtA ,i■l 1,
MY COMMISSION EXPIRES 07 76 19 J-'<
DATE3ONDED MOW GENERAL INS , UNDERW ,I IF "'
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the I'1.fnnir.it 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 anti /or workmanship.