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9723 NE 2 AveMIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal of the detailed statement ut 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, whcther herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. �j Date..._...._ _.. _... _� �. ..._... 19 Owner's Name and Address ` ,_.. .. is _. No 7 �. re � :C 4 -. , :jic;:.. Kfjcr <� Registered Architect and /or Engineer ..... ........... +nx..w,•e•s„ er -•. :. Name and address of licensed contractor s 63 .5 .k F..i ?.^._1..`C).`Q..Z._.1.11la.). S. `jr ............._......__ Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done , A. .._ i■.E State work to be done and purpose of building ( rs) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer peared stated are g Permit No.._.. °_4!v.f1 27 r Date e y t ` e Disapproved (Signed) ate. Building Inspector PLANNING BOARD DATE � . : . = ^ ... eve . ........_.._.._ and for no other purpose. Ncw Building Remodeling Addition Repairs N p l _ `Stories To be constructed of Kind of foundation r Roof Covering Lt — L '_1 Estimated Total cost of improvements $ 4-- (' :c) Amount of Permit 5.....s�l.Q`© 0 Zone cubage required .Plan Cubage Distance .to next nearest building.. Size of Building Lot lfaxiinum live load to be borne by each floor Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires 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 employe by him in the work to be performed under this permit; and will post or cause to be posted for inspection •` the site of the work such ublic notice or notices as are required by the Act. The undersigned agrees to employ only suN subcontractors, • . work .. . • . .ender this pennit, as are licensed by Miami Shores Village. Remarks __._.__ (Signed) oaths and take acknowledgments. personally ap- 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 t h crctm b y hi m at d re Member Member Member ...._ __.. „....._ Chairman Member Member .. .. _ ....._.. Council Approved Date Disapproved Date NOTE: A charge of 31.00 will be made for making corrections or changes to this application niter approval has been obtained from the Planning Board. A re fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.