28799MIAMI 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 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 contractor
Location and legal ip ' of lot to be built on:
Lot /"/.� na 44.4 ' dt 5Bkmk /0/ Subdivision igAl �/ RAP /1 862-Pi /V ✓ 70
Street and Number where work is to be done 6 c we, ,? p 2" /°'°:4" c S42,42_ , 23/3k
Date ®.9 - eye- 19
Na. 617 Street Vie. 9? ice,
/ VG -o /2/ 22% 8e �O L abbc€2,0g7 aces.
State work to be done and purpose of building (by floors), state exterior cobs ( t 9
ye®f (b1 4 7 4tf—D
7 `"
New Building Remodeling
To be constructed of Kind of foundation
/6/3- CO Amount of Permit $
Plan Cubage
• PIN
Estimated Total cost of improvements
Zone cubage required
Distance to next nearest building
1/4
Maximum live load to be borne by each floor
lot
and for no other purpose.
No. of Stories
f Covering
ize of Building Lot
I hereby submit all 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 obligatons as an
Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with
compliance from all contractors ar sub - contractors employed by him in the work to be performed under .,- and
on the site of the work such public notice or notices as are required by the Act. The undersigned _ ._ ploy
under this permit are licensed by Miami Shores Vile. k/J
Remarks
eeQGtr / aS
STATE OF FLORIDA } ee. el a a s/
COUNTY OF DADS.
Before me, the undersigned authority, a notary public, authorized to ter oaths and take acknowledgments, personally appeared
! /� ®/ / ' � 4 / to me well known.
and who. being by me first duly sworn, upon oath deposes and says that he is the a6/9 i ei
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.
employer of Labor under the Florida Workmen s
the provisions „/ and ' ? require similar
will post or cau 1��7, be , , �f d for inspection
subc , on to be performed
Permit No.
Disapproved
(Signed)
I v 1 ! l Date
Date
Building Inspector
PLANNING BOARD DATE
Read, S ,, to and Sub
of lri,,t SIG "d - s;Q-
iskikkaLutliDA
'Fa 5,1991)
My Commission Expires Dt�i °d!76U THIU G� "F,
Chairman Mem
Member Member
Member Meer
Council Approved
Date Disapproved Date
NOTE: A° charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.