No Permit NumberMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTIVEkIT
APPLICATION FOR BUILDING PERMIT,
Application is hereby made for the approval of the detailed statement of the plans and sp cifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and con10 ty with the Building' Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of IVliami 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 1'`
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 6 f
Date
y� k
Sixeet_.24T4
State work to be done and purpose of building (by floors)
s P
To be constructed of Kind of fo Addition _ _� Repairs !� ___ No of _� 6'i
New Building Remodeling _ —_._ —� r
undati . � £� � Roof Covering f �2,„,<
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required_______
Distance to neat nearest building
Maximum live load to be borne by each floor
I hereby s br;6it 'the plans and ecificatio
be sent to cif-
The t�
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 Sup�plement,
and has complied with the provisions thereof, and will require similar compliance from all co tractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for insp on on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcottrai ors, on work to be performed under this
permit, as are licensed by Miami Shores Village
Remarks . (Signed)
and for no other purpose.
Plan Cubage
Size of Building_ _Lot_
said building. All notices with reference to the 'building and its construction may,
STATE OF FLORIDA,
COUNTY OF DADE. SS.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowieclg�rrts, personally ap-
peared
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 tb e 11 acts
therein by him stated are true.
Permit No. rs Date _` A-?-t ?Read, Sworn to and Subscribed before ine.
Disapproved A. Dat
(Signed)
Chairman
Member'
Member ti /L}cS �. �{
Notaryi; Public, State of Florida
My Commission E*pires r
{.a A4
Council Approved -
NO'1'E: A charge of $1.00 will be made fpr making corrections or changes to this application after approval has
the Planning Board.
Member
Member
Member
Date Disapproved Date
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessar' by improper notice for
materials and /or workmanship.
been obtained from
inspection or faulty