1976 SIDEWALKS.wner's Name and Address
pPLICATION FOR BUILDING PERMIT
the approval of the detailed statement of the plans and specifications herewith submitted for the build-
,.,eribcd. This application is made in compliance and conformity with the Building Ordinance of Miami
ail provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
•.,ng Division of Miami Shores Village shall be complied with, whether herein pecified or not. A copy of approved
..ons must be kept at building during progress of the work.
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. — l5
State work to be done and purpose of building (by floors)
Permit No.._ Date
Disapproved _.... • / - -- -__ D"le--- ••-- - -• - -.
(Signed)
Building J s c r
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date..._.
19..
_. No <3 .5 t;'L 5;7_
ead, Swo
•
} S S / A% t' /Z o //4L ' 'V
- Y 6 ����_`
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation Roe Cyering
of ..._.
Estimated Total cost of improvements $ .QIJ Amount of Permit $.
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the 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 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 contractors or sub - contractors employed 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 the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcon i 1 or work to • , rf•g ed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)_.
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 say that he is t
of the above described construction, sat he has carefully read the oregoing application, and that he did sign the same, and that all facts
therein by hiss stayed
to and Subscribed before me.
to me well known,
Notary Public, State of Florida
My Commission Expires
PLANNI1 BOARD DATE
Chairman Member
Member Member
Member ...... Member
Council Approved Date Disapproved 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 !loard.
A rc in>t,cetion 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.