1053 NE 91 Terr (7)Application is hereby usnde for the approval of the detailed statement uI 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
plots and specifications must be kept at building during progress of the work.
Date..._......�L_4�/ __..__._.......__._ _ fi r - ,190
Owner's Name and Address ..... ge(4/ _ No.s/ / � ... street ._.y / /re-
Registered Architect and /or >yngincer .... airy' olio P L 2 e z/. c Q.s5.. . / 1� - a 3 ... ,,,,,,,,,,,,,,,,,,,,r_„ ... ,
Name and address of licensed contractors rQd20.tri & !V
Location and legal description of lot to be built on:
Lot ,.. Block Subdivision _ _ .._.._....._._......._..._...,
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
_ _._.._ en.fmr� Q
and for no other purpose.
APPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
Ncw Building Remodeling Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements $ 3o.d• dv
Disapproved /►,...�. ".,.. Date
(Signed)
Amount of Permit S..
Repairs No. of Stories
n , f Covering
B '
Zone cubage required .Plan Cubage
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 umicrsicncd applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Honda \Vonl9nen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied ssith 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 arc 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)
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
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.......:! Date C Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Ciiainnan .. , .. Member
Member Member
Member Member
Council Approved Date Disapproved
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval h
the Planning Board.
A re inspection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.
as been obtained from