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1025 NE 91 Terr (9)1 M Street and Number where work is to be done New Building Remodeling To be constructed of'� +' Permit No._. Disapproved (Signed) AMO SHnRES V BUR -DONIS ONSPECTOONI D[EBA AFFUOATllON FO Application is hereby .nude for the approval of the detailed statement of the plans and specifications herewith submitted foe the bui!ax•• 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 c!: rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specific& 02 G et. A copy of appeeeve d plans and specifications must be kept at building during gtmresa of the work. Owner's Name and Address ... aa2- o. -nz_Kz ,o._,MaQ09d__ -lam £)- Registered Architect and /or Engineer.... acm i3 -. ptV , - -n 1e-e) °C•ggc? {3 Name. and address of licensed contrpctoe A:,?:' X CUSTOM ? -.GQ:. Location and legal description of lot to be built on: Lot II 3 e � � Block U Subdivision E7atrt�r��c State work to be done and purpose of building (by floors) Y:lig iitag.J O.O. sad ffor ato other p:eeptic . Kind of foundation (sof Ctnergyee7, Estimated Total cost of improvements $ 1 Atom© Amount of Permit &. ao.� Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot J25 X na )D 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 melt 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 fro II CD.It/Ct4r5 0:' su „ ,.,:tgactors employed by him in the work to be Performed under this permit; and will post or cause to be posted f 4 of the work such ubl' • eiee or notices as are required by the Act. The undersigned agrees to employ only sue �e r RLtac4• , ol�� ? C pert mndee pennit, as are licensed by Miami Shores Village. ! 7 Remarks._ -_ (Signed 8 STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take achnc:w 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 aane, tad that all Lees therein by him stated are true. �— Date ' 7 Read, Sworn to and Subscribed befoec gate. Date. uil..i g Inspector Data. Chairman Member \fcrnber Member Member ... _- --- •_ --•_ ___.._ Member - - -- Council Approved Date Disapprovve& LLA E i-r RJIH_M pEQM117 TMENT PLA ING BOAR its DATE Addition Repairs No. off Stories Notary Public, State of Florida My Commission Expires NOTE: A charge of $1.00 will be made for making oerrectiona or changes to this application after app•rrva•a7 the Planning Board. A re-inspection fee of 2.1.00 will be charged when such re°iwspectiuro is mode necessary by improper crttee Ecoa inepmtion c ffetsit}y materials and /or workmanship. to me well Effiow.e, hes her obtained feree.e