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MECHANICAL(MIAMI SHORES VILLAGE BUIL151NG INSPECTION DEPARTMENT APPLICATION FOR BU PERMIT A c !,,tron is'hercby upndc for the approYal of the detailed statement ur me plans and specifications herewith submitted for the build • :at; et other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami Vc!l.tge, hinrid.e, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the i.iuileling 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.i/ tJ:–/.T_..__ 1.,Z -. »....19. Owner's Name and Address .KE.t4 G L t t ,- H©-.- _ _. N0.12- 3._... Street' E _ I . Z s t Fcgistcrcd Architect and /or Engineer Name and address of licensed contractor & t2-Gk r4,_ C t4O -'1 INN I1..6- CY .p. GI 30 NIA Location and legal description of lot to be built on: Lot CO Block 1 E3 2 Subdivision f 3 i d 'y 62 ..5c L- T!ob__ off' en ipn, 5 Horze S_ S and Number where work is to be done.... Z - 3 _ l`r' r L z 5 .._ _-_ - -• --- -- State work to be done and purpose of bui ing (by floors) Z NS , T.r1 ._ y T C ��C-t= m , A-l S e,.-S :s7-...or,....... � oae�5 M S 19 -5-1 l J C &. i - 1..- • s . . t .. . E p Or 7D:t_...1 ... $. ... -p L xf» peared ttg and for no other purpose. Addition Repair, No. of Stories 1 Roof Covering New Building .......... Remodeling To be constructed of Kind of foundation Estimated Total cost of improvements S 4 /200 ?mount, of Permit S..1 "Lone cubage required .Plan Cubage Distance .to next nearest building Size of Building Lot w live load to be borne by each floor t 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.. ... .. applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer c. !.thur sander tic r lurlda %Workmen's Compensation Act, being Section 5')GG, Compiled General Laws of Florida, Permanent Supplement. and !,.es complied .ecth the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him upon: 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 are 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. Remarks (Signed 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- to me well known, and �•no, being by me first duly sworn, upon oath deposes and says that he is the. of tl.e 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. . Permit No.._....� — 17 -.1 Date / . 1 .... 1 Read, Sworn to and Subscribed before me. I Disapproved Date.._.. -- Notary Public, State of Florida (Signed) `.• Building Inspector My Commission Expires --- .--- -- PLANNING BOARD DATE Cnair.nan Member Nlcrnpber Member Member -,_- Member ._ - -•.. Come.i Approved Date Disapproved Date NUT(•:: A ch.irge of $1.00 will be made for staking corrections or changes to this application after approval has been obtained Iron) tic l'I.cnnir,;; l:u.ird. A re•in•pci tom Ice of 51.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. THESE PLANS ARE APPROt'ED FUR ISSUANCE Oi: A BUILDING PERMIT l'AP,IA!''CE(S) L STED IN "REMARKS" M1 "•II SHORES BUILDING FWD ZONING U^ILt''> SPECIFICALLY LISTED BELOW. AND cou; v LAWS MUST BE COMPLIED Ant' -A S e9'ture Date • WITH NO VARIANCES • WITII NO OTHER DEVIATIO :S FROM THE ORDINANCES WILL BE PERP,IITTFO. ALL OTHER APPI ICAB'..E STATE WITH BY ALL PARTIES. FIRE DEPARTMENT PUBLIC WOR■fS POLICE DEPARTMENT BUILDING DIRECTOR 1 7 )04, PLANNING & MIA BO VILLAGE COUNCIL APPROVAL PRELIMINARY: FINAL: REMARKS: COMPLIANCE WITH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED BY MIAMI SHORES VILLAGE IS REQUIRED. TIE ARCHITECT, BUILDER & SUB CONTRACTORS ARE r-" "'tip' — K" OWL EDGE OF ALL BUILD- ING REGULATIONS WHETHER OR NOT SPECIFICALLY INDICATED HEREIN. 4, , L 3 - KITGHt 1 M . 23 0 c. 141 ,C 1 0 rvt 0 X 0 w4Tai • UN() Of,YK, Jc_. 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