MECHANICALOwner's Name and Address..
New Building
To be constructed of
SS.
AP'-°LICATIDN FOR
MIAMI SH 1 RES VILLAGE
Disapproved „ D
(Signed)
uilding In T tor
BUILDING INSPECTION DEPARTMENT
Chairman
Member
UILDING 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 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 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.
Registered Architect and /or Engineer .... ._.. / _ fJ
Name and address of licensed contract ..1 t d/ ,?- c �
Location and legal description of lot to be built on:
Lot Block � Subdivision � ,.e..)-- ,.e..)-- Street and Number where work is to be done ��
State work to be done and purpose of building (by floors) . >— l
and for no other purpose.
Remodeling Addition Repairs
Kind of foundation Roof C
' & at " Amount of Permit $
Date C:= , -
No. ._
Estimated Total cost of improvements $
Zone cuhage required Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby sum it all the Tans a specifications for said bu" 'ng All notices with references to the building and its construction may
be sent to °�— 0~
. `�`— ,.��./ `'.??� _.tom 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 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 ins ection on the sit of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcX tract trs, on w9c to be P�fyrwed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
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 stated are true.
Permit No ' crp Date Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
No. of Stories
My Commission Expires
PLANNING BOARD DATE
Member
Member
. .Member Member
• Council Approved Date 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.
MIAMI 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-
O� 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 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.
Owner's Name and Address.... n
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Su iv 7>n
Street and Number where work is to be done
•
State work to be done and purpose of building (by floors)
To be constructed of Kind of foundation
Estimated Total cost of improvements $
Zone cubage required
Chairman
Member
Member ...
Council Approved. Date
Date_ .. / ,19�.,/C
No ` .. Street ! 0 ��1
Notary Public, State of Florida
ANNINC BOARD DATE
Roof Covering
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
a� ,`e€,/ 2 '-
and for no other purpose.
New Building Remodeling. Addition Repairs No. of Stories
Amount of Permit $
-Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby sub ll the plans d spec' ' lions for said buil i g All no with reference to the
be sent to buil
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, Pennanent 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 i pection on the sit of the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such su ontra•• ors, on J to be pe. _ • • . under this
permit, as are licensed by Miami Shores Village. �i •
Remarks (Signed) l
c� nstyect'on may
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
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 stated are tru
Permit No._ f e4J Date !f " Read, Sworn to and Subscribed before me.
Disapproved _____ Date
(Signed) .44 - _
Bui ding Inspect • -- My Commission Expires
Member
Member
Member
Disapproved Date
has been obtained from
for inspection or faulty