15339performed under this Permit .
Legal Lot
Description.
Address of
Building
This permit is anted to the` contractor or b ; . er named above to
herefor in strict co a n all ordinances p ?: ' , 'ng thereto and
drawings, statements or specifications that may h =`e been submitted to an
time if the work is not done in compliance with such ordinances or if the pi
granted is the understanding that the contractor or builder named above
pertaining to the work covered hereby whether shown on the plans or dr
done by his agents, servants or employees.
Subdi-
vision
Value of
Project $`
struct the building or to install the eq i t "e e d
the understanding th, the work wt'iT
approved by the pro .. ntwncipal authors . T his
ns , , ed wi . au rization A filer ••_, ,* , w i is
for a thorough sail re ations
ngs or in th .ta; ents or r "fief - and that he �,, .. r i s for: work,
Signed:
In consideration of the issuance to me o is permit I agree to p
pertaining thereto and in strict conformity with th .. ns, drawings stat
In accepting this permit I assume responsibility for a r done
INSPE
form the work covered hereunder in oomplia.
ante or specifications `submitted to the 'proper
er, myself, my agent, servant or employee.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMEN'''
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 heroin described. This application is made in compliance and coniormty with the Building Ordinance of Miami
Shores Village, Florida, and all pro,isions of the Laws cf the State of Flvrid. all o d.nances uf Mi ,:rn Shores Village and all rules and
regulations of the Building Divii,i(n of Miami Shot; illage .^oi ipLed with, whether herein specified or not. A copy of approved
plans and spec:Beat: 'iv must be kepi at building durin6 progress of tl.e wcrk.
Owner's Name and Address Yi) ' ALE AMR
Registered Architect and/or Engineer__
Name and address of licensed contractor. _
Location and legal description of lot to be built on:
Lot _ Block_ Subdivision
Street and Number where work is to be done_
Date_______
No._ Street.
19`g
State work to be - and purp of building (b •
4.40 '7' • 'I. 41r4 Avr
New Building_ _ Remodeling_ _ _ Addition__
To be constructed off — Kind of foundatio
Estimated T3tal cost of improvements 11_
Zone cubage required
Distance to next nearest building_
Maximum live load to be borne by each floor_
hereby submit all the plans and specifications for said building. All notices with reference to the building and its Construction may
be sent to
and for no other purppse.
Repairs. _ _ _ No. of Stories_
Roof Cov srin
ount of Permit $._
_-Plan Cubage_
_Size of Building Lot
The unde-signed applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under .he Florida Worlcmen's Compensation Act. being Section 5968, Cor-pled Gen. ral Laws of Florida, Pora-nanen. Supple asent,
and has complied with the provIcions thereof, and will require similar compliance from all contractors or sub-contractors ernploiied by him
in the work to be pertirmed under this perniit and will post or cause to be posted for inspection on the site of the work such public noti,
or notices as are required by the Act. The undersigned agrees to employ only such :.:ubcontr. ctors,®p ctorspi.work to be perforne.d .'der this
permit. as are licensed by Miami Shores Village.
Remarks__
STATE OF FLORIDA,
COUNTY OF DADE.
SS.
(Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally tip-
peered
and who, bein,
of tho abov
therein by him
Permit N
Disa
.4
upon
a .„:_v_kiik.., ,, --II says that Ile is the .
, vve;,I r tlatforegomg application, and that he did sign the same, and that all facts
Read, Sworn to and Subscribed before me.
_ to me well laiown,
.10
Notary Public State of Florida
wilding I My Commission Expires_
Chairman Member..,.
Member Member -
Member — Member
7 Conn il Approved . _ _Date Disapproved
materials and/or workmanship. Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval h is been obtained from
t e 3Plann:ng Board
A re-inspection fee of $1.00 will be charged when such re-inspection is ma „le necessary by improper notice for inspeition or fa, ity
PLANNING BO
... _DATE