1235 NE 98 StSTATE OF FLORIDA,
COUNTY OF DADE.
Chairman
Member
Member _
Building Inspector
materials and/or w manship.
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a / ir e K (\ 3 - ,,,J c.,
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 building
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 regula-
tions 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------ --- T O -- - 19/x? _
Owner's Name and Address Q _ A' 't /Z /� No._______-__-- Street — _ _ __—_
Registered Architect and /or Engineer_ —,.7 ' 1f h dC_!� . .t'yi�f_L_ ___�____� 'D�+ ___�_
Name and address of licensed contractor -- /�dQ,�t/t •, ,Qlat_ . . . A.C.
Location and lefial description of lot to be built on: MJIJ ``
Lot / S Block— ___ Subdivision . _ r �A _E / r .S0von r �r i�L�
Street and Number where work is to be done / ate 1l_.____11/ - �_ �__ „__ 1L1 » _
State work to be done and purpose of building (by floors)
/Sro e y L°.e Ras ocNai ,, At, ___y,At /
------------- _and for no other purpose.
New Building ✓ Remodeling______________ Addition Repairs No. of Stories_.._._f _.___-_
To be constructed of__C_a ____ Kind of foundation el.eIGG4_� le___� Roof ` Cov r !__!4 _ f �_ _ _. —_�__
Estimated Total cost of improvements $ — /j OQQ 1'
_Amount of Permit $ (�'� // f
Zone cubage required_ 2G 0 O 7 Plan Cubage_____—__ _____._. _�.. —i__ _ S� __ –_ _ __ _.___
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit al the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to /ATON' �DOAgg IrA+c, 'RD..aix 1 4 y .677.4 tiPrrr-
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 ' ection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such au la tractor, /'n wgxls Ito be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
PLANNING BOARD DATE
Member
Member
Member
My Commission Expires
0
(Signed)
OA
_
o
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that be is the
of the above described construction, that be has carefully read the fgregoing application, and that he did sign the same, and that all facts
therein by him scat d are e. c /� '1 '/
Permit No v Date _ v / / _ Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
(Signed)
Council Approved__________________—_Y ____________w_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 spection is made necessary by improper notice for inspection or faulty
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