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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 described. This application is made in compliance and conformity with the Byil g Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State .of Florida, all ordinances of Miami Sh9fes lage and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein pecifjed or ot. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and le al description of lot to be built
Lot Block
Street and Number where work is to be done
State work to be done ar}d_gurpose of buildin
New Building Remodeling Addition Repairs
To be constructed of Kind q i dation Roof Covering
Estimated Total cost of improvements $ 4.' _______________Amount of Permit $
Zone cubage required __Plan Cubage
Distance to next nearest building Size of Building Lot
STATE OF FLORIDA,
COUNTY OF DADE. ss.
peared
jam_ ".cc�
and who, being by e first d y worn,
of the above describ d constr ct on, that
therein by him state • are true
Permit No
Disapprove
(Signed)
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
Inspector
Subdivision
by floors)_
Council Approved
Date
Date
19 gt
Street
and for no other purpose.
- No. of Stories
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
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 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 wor such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work l,6 be ` -rformed un
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
_ 1J— Read, Sworn to and Subscribed before me.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
to me well known,
on oath deposes and says that he is the
e ha's carefully read the f regoing, application, and that he did sign the same, and that all facts
Notary Public, State of Florida
My Commission Expires
PLANNING BOA)ID J DATE
ember
ber
Member Member
Member Member
Disapproved 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 Planning 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 and /or workmanship.