575 NE 87 St (13)Application is hereby made for the approval of the detailed statement or ine plans and specifications herewith submitted for the build
inc or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Flnrid.t. 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
Registered Architect and /or Engineer
Name and address of licensed contactor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done .
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved
(Signed)
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APPLICATION FOR BUILDING PERMIT
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Building Inspector
MIAMI SHORES VILLAGE °��S— cf'3 y/
BUILDING INSPECTION DEPARTMENT
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Chairnan
Mcrr.bcr
Member .. _.....__....._.---._ ...._.._....
Council Approved Date
No,c -7..Y .._ . eet..22
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State work to be done and purpose of building (by floors ). i Z t' _ e t . `e'er
Addition Repairs No. of Stories
New Building Remodeling
To be constructed of Kind of fo dation Roof Co Bring
Estimated Total cost of improvements $ US ' Amount of Permit S. � l� ;
Zone cubage required Plan Cubage
Distance .to next ne.uest building. Size of Building Lot
Maximum live load to be borne by each floor
I hereby sut 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 hal-complied with the provisions thereof, and will require similar compliance From all contractors or sub - contractors rnployed by him
in the work to be performed under this permit; and will post or cause to be posted for inspectigri on the site of the work uch_public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontr ors, on to be ed`rnder this
penni` as are licensed by Miami Shores Village. / �/� ' !f � ,,,/ Remarks (Signed) (� /� �� %�
and for no other purpose.
e, 5X3070.3
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared _..
M 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 a true..
Permit No.._. 11 . J Date4 7/ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
NOTE: A c•h.ugc of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the 1'L9nnir.g llo.rrd.
A re -in' pection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.