9501 NE 2 Ave (2)Street and Number where work is to be done_
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 ke t at building during progress f the work.
J A / � �
Lc-
/ Date — - , I9,T
Owner's Name and Address._
Registered Architect and /or Engineer. _ __. // --
Name and address of licensed contractor___'ii/' de:a. P 1'.__ /f_ 97
Location and legal description of lot to be built on:
Lot Block
Subdivision
State work to be done 9nd purp se of blinding (by floors
New Building ,jj Remodeling Addition
To be constructed of____ ` Kind of foundation
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor___
I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may
be sent to. - -- - -
The undersigned applicant for this building permit doc:, 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, Pennanent 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks_ _ ( Signed
Permit No t
Disapproved
(Signed)
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date -�'
____.. _ __
Date
No Street
and for no other purpose.
Repairs
Amount of Pe it
.Plan Cubage_
Size of Building Lot
No. of
Roof Covering
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector _ / My Commission Expires
STATE OF FLORIDA,
COUNTY OF DADE. J ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, 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 that all facts
therein by him stated are true.
PLANNkNG BOARD._ ... DATE
Chairman _ . Member
Member Member
Member ....... Member
_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 Board.
A re- inspection 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.