11702MIAMI SHORES VILLAGE - 7SV 7-5V/
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-
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_ _ ..�!'Y 5 _. 4;_ %
Registered Architect and /or Engineer___ _ - . . -, 0.r.t
Name and address of licensed contractor -. _ Oa!erie S' i.. -...._. Ey9 ,00/4, '
Location and legal description of lot to be built on: '57 /y09ie.dp.e ISA , C°Y Rees
Lot__ __ _ . ____ Block__ Subdivision - Q —
State work to be done and urpose o building (by floors)_ _- ___ -___ -______-- •___.__- .,__._�
�',.er -fie - i - _,f/_doi r Co -sexi V. e_ _ r _ 2._ "...BSI .
:---_.._.-..and for no other purpose.
New Building_ ___ Remodeling_ ✓- Addition Repairs _-._ __-_ No. of Stories
To be constructed of Kind of foundation.._. _ egg_
_.___ --------- _.__ -- ._ -- Roof Covering
Estimated Total cost of improvements $_ JD 0 Amount of Permit $__________
Zone cubage required---_--______ -___._ ______ _.,_.._.Plan Cubage -- -- -- _ - - - -_ _ _-- ____ - --
Distance to next nearest -
building_ �%Q
g .. _Size of Building Lot -. ______ ._,____�__. - --
Maxifnum live load to be borne by each floor__
I hereby submit all the plans and ecifications foz said building. All notices with, reference to the buil ' g d its co structio ay.
be sent to--- - - - - -7 4t4, - _ / /� /0 4. - -- —. A y ,�!s
The undersigned applicant is building permit dqt, hereby certify that he understands and accepts s •
ccep 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 rovisions thereof, and will require similar compliance from all contractors or sub- contractors a iployed 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 a -work such ublic 4otice
or notices as are required by the Act. The undersigned agrees to employ only s ,ntr: - us, on work be: perfo . = r this
permit, as are licensed by Miami Shores Village.
Remarks-- --_ -- - - - -- ( Signed) _
Date_ , 19_.1
No.I72 - - -- -- Street_., . fa 7V
Street and Number where work is to be done
STATE OF FLORIDA,
COUNTY OF DADE. ss°
OVERSEAS > HEAT PUMP
157 -Harbor Drives
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and to a agmette s ally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that be 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. f @ �_� _ _� Date_____ __ r Read, Sworn to and Subscribed before me.
Disapproved Date_ .__
( Signed) __ _
Buildin . /, • spector My Commission Expires_..
PLANNING BOARD- -
Chairman Member --- - ___ -•- -.
Member ___________
- Member -------------- - - - - -• Member Member ._._. _ ._.._.
Council Approved__ .___ -- _-- _- --- _--- -. -� -- ___ -- - -_Date Disapproved
to me well known,
Notary Public, State of Florida
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.