1025 NE 91 TerrMIAMI 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.
��
Date ,19
Owner's Name and Address ._.... .c£' 1 C", 6 .� / r�_�=1z No /Y(? Street .4
Registered Architect and /or Engineer. ...._._'..'. a G 'i ,
Name and address of licensed contractor a �...ea , '.eaf.® / 6 '.efi' ..Q "IX)
Location a, 1g al e cription pf tp be built on:
Lot/FA � ° ' .3 1 ° block / _Subdivision .V s'.S___. _. �.
Street and Number where work is to be done..../a..;6/ ___ /I V, • lrg , ft /j
State work to be done and purpose of building (by floors) J__._ / :_ _ e_._
_d 6_ e.:_. C2.a v - .. rs�...4.N
New Building Remodeling. Addition ep 'rs No. of Stories /
To be constructed of__ ,. Kind of foundation. ._. ti Oka- �_F_ _... . • Roof Covering Ay: t � ....� e �ic
Estimated Total cost of improvements $_.ele 0 ° " - Amount of Permit $ ` c; "C'
Zone cubage required Plan Cubage
Distance to next nearest building _.......I -- ' ° / /Fa Size of Building Lot e:).1, ' / :'' , ` 9
Maximum live load to be borne by each floor v
I hereby submit all the plans and specifications for said building. All ikotices with reference t the building and its construction may
be sent to.._
The undersigned applicant for this building pennit 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ' (Signed) 4_ ,-� ��-._� t:z 1, :, v/. o _., ) -. .,-//'
2..
and for no other purpose.
STATE OF FLORIDA, i
COUNTY OF DADE. 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.
Permit No...... L...- _ Date ` .?" `�7 Read, Sworn to and Subscribed before me.
Disapproved Date . ; ,?
, i7 �� Notary Public, State of Florida
(Signed)
ilding Inspector
My Commission Expires
PLANNING 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 fro
imnrnner notice for inspection or faulty
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1774 W. Flagler Street
MIAMI 35, FLORIDA
Phone:: FR 9 -3508, FR 1-0227
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OR ER NO, ' 7
HEREBY CERTIFY that the attached °hatch reprccen;
Furvey made Tinder my direction and is true and correct
There are no encroachments pt, . shown.
REGISTERED LAND SU OR
STATE OF Rim,
X 7, 5 ,
According t: the Plat tLterecff a€ rEOQrdE6. it ?let kook
Public Records of Dade County, , FIQa d.E
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DEAL 4/ 7
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