AC replacement-1974MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
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 descqribed. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all pibvisions 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.
Date.. _�...J� 1...�.�r..._..._.... _._ ..... ,19..1
Owner's Name and Address .MQ.... G s ,\t , .__ No...1. 77 . Street_h) g _.too ST
Registered Architect and /or Engineer �" �., `t.A
Name and address of licensed contritctor....
Location and legal description of lot to be built on:
Lot Block Subdivision r
Street and Number where work is to be done 3.5,S 1� • _E_....100 r- _...._.._._
State work to be done and purpose of building (by floors) 2. - 3101J AM. ...cm. t? tT_.4.O!4?
L N. s...........i .� .._._ s �'r'_�o�J�l, .......s.�s'tt�M R�IC E
_. 1.1. k r�- IL�•►..1. �. �f �4l� ' and for no other purpose.
New Building Remodeling
To be constructed of Kind of foundation
Estimated Total cost of improvements $..7QQID
Zone cubage required
Distance to next nearest building.l�►,C�/.1.oco.,e _... ,��^ Size of Building Lot
Maximum live Load to be borne by each floor `—
I hereby '' suu \ bmi all the plans and specifications for said building. All notices with reference to the building and__its construction may
be sent to......'t.4
The undersigned applicant for this building 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, P nnanent Su lement,
ntract • ors employe by him
on the site of the work such public notice
ors, on work to be performed under this
and has complied with the provisions thereof, and will require similar compliance from all
in the work to be performed under this permit; and will post or cause to be posted f • to
or notices as arc required by the Act. The undersigned agrees to employ only such ubcon
pennit, as are licensed by Miami Shores Village.
Remarks..._ (Signed)
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 — ••
Permit No..
Disapproved
(Signed)
Builds
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 sa are true.
6;7 /. 0 '3
Date
Date.
nspector
PLAN
Chairman
Ntcrnber
Member _..._._..._.�..--- _ - - -..
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re inspection fee of $1.00 will be charged
materials and /or workmanship.
51sp w /rj n tit- e
ene..
_1�. qvE
Addition Repairs No. of Stories
Roof Covering
Amount of Permit S. '
.Plan Cubage
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
INC BOARD _.._ DATE
Member
Member
Member
Disapproved
or changes to this application nfter approval
to me well known,
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty