No Permit Number (2)MIAMI 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 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 Addr . L' evni�
' Registered Architect and /or Engineer_
Name and address of licensed contractor
Location and legal description of lot to be built on:
Blocky Subdivisi
Street and Number where work is to be done ' 7 —
State work to be done and purpose of building (hy floors)
'° ,19_
_ Street_"
o
New Building Remodeling Addition
To be constructed of Kind of foundat - -
Estimated Total cost of improvements $-42..�6 Amount of Permit $
Zone cubage required_ Plan Cubage 1/3
Size of Building Lot
Maximum live load to be home by each floor
I hereby sub a plans ands ' 'cati o y9 for or 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 has complied with the provisions thereof, and will require similar compliance from all ooniractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspecti on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon• : crs, on work to be perfumed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
and for no other purple.
No. of Stori 1
Roof Covering
Distance to next nearest building
STATE OF FLORIDA,
COUNTY OF DADE. SS'
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 s
therein by him stated are true.
Permit No ' Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of, Florida
(Signed)
to me well known,
e, and that all facts
Building Inspector My Commission grsiires
PLANNING BOARD _DATE
Chairman _ Member
Member Member
Member _ Member
Council Approved— Date Disapproved mate
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 1py improper notice for inspection or faulty
materials and /or workmanship.