1042 NE 91 Terr (2)APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement of toe plans and specifications herewith submitted for the build
inc 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.
Owner's Name and Address .... 7 e6 5 4 2 - &ill 1 e-. No / `ip 4 Street_ /47 • i��,�,i -/,�/'
Registered Architect and /or Engineer " J
..
Name and address of licensed contractor ..... J s.... &..4J.....6A,is gei7ie vi :d1 - .4/P S /-� �.7' Mi.11. 117.2.. ?, / q
Location and legal description of lot t be built on: .
t o � �2
Lot 6 t 7i'e4f t- �L IA l rock/ �If /'� ® Su d son eta .' < �6 I art'g -CgA C'g J ,4-7 , i4.1)
Street and Number where work is to be done ..... _.!4—• .l_ A � /.� t7
State work to be done and purpose of building (by floors) <PF1(L =_ 5T1P --
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I f J .Le. 3 E -6,10p 4 '� . �s ,-PpLEr
New Bui!ding '- Remodeling Addition
To be constructed of hind of foundation.
Estimated Total cost of improvements $ ).2
p
Zone cubage required
Distance to next nearest building
MIAMI SHORES VILLAGE
\faxirnum live load to be borne by each floor
i hereby submit all VIans and sees fications� r said building. with reference to the building and
sent to.. ��.�/�`' ��....` l`.f y la .. /�.y,� T �J . /.�� .. ...�.!�'
MI notices
be s / l //
J
BUILDING INSPECTION DEPARTMENT
/..f
Date..
19.
Repairs'
LLra...Amount of Permit 5..... .
.Plan Cubage
Site of Building Lot
and for no other purpose.
No. of Stories / _
vering. 7 77l . _
1..x:...1
its construction may
• The under,iencd applicant for this building perinit 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 rovisions 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 inspectjon on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su attors, on wok to be..ptrformed 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
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, rnd that all facts
therein by him stated are e.
Permit No %!.1.1. Date 0 .�..... 9 Read, Sworn to and Subscribed before me.
Disapproved ....,�1 _ ..
4...... Date
V3-� 1t0GL
(Signed)
Notary Public, State of Florida
Building 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 nfter approval has been obtained from
the I'I,rnnir.,. Board.
A re nrpection fee of $1.00 will be charged when such re inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.
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