1050 NE 91 Terr (7)4
Registered Architect and /or Engineer
Name and address of licensed contrictore�
Locatn n description i d leg31 dipti of lot to be built on:
Lot.b Block
Street and Number where work is to be done
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Subdivision.
a
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of me 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
Shorts 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 bc kept at building during progress of the work.
_ Date..._...._......_ ..� I op . _.. ,19 .813
Owner's Name and Address ...... Street ��' 9i `r&i2 e
ntr. vn•••n •tilt »ate »nt•p
CIA 4 '4126 , e7A - 1'.6 . . 5 0 cg-
- G� i'��a ify l
_ Z . & J _ _ . J d . 7 9 1 3 5 i 3 5i
State work to be done and purpose of building (by floors) .. Y. 1e9.0
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation p Roo Covering
Estimated Total cost of improvements $..gt••4 Permit $.•.1
Zone cubage required
Distance .to next nearest building.. Size of Building Lot
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 may
be sent to
The unflcrsigncd applicant for this building permit does hereby certify that he undo
of Libor under the Florida Workmen's Compensation Act. being Section 59(36. Comp,
and has complied with the provisions thereof, and will require similar compliance fr
in the work to be performed under this permit; and will post or cause to be posted
or notices as arc required by the Act. The undersigned agrees to employ only suc
pennit, as are licensed by Miami Shores Village.
Remarks (Signe
Amount of
_Plan Cubage
and accepts his obligations as an employer
eral Laws of Flori• :, ennanrnt Supplement,
r sub- •. ntr Yctors employed by him
e site t , 'work such public notice
wor / t • ' • performed under this
2
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
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, aind that all facts
therein by hire stated are true.. 11
Permit No.._ Date.... !° i Read, Sworn to and Subscribed before me.
t
Date.
Building Inspector
Notary Public, State of Florida
My Commission Expires
•pzti/q7
to me well known,
PLANNING BOARD DATE
Chair.nan 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 fmm
the Pl. nnir.g Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection oe faulty
materials anti /or workmanship.
BRIAN VAN BOWER
President
(305) 868-4633
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1,/ c4 ® * Spas & Decking
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North Bay Village, FL 33141