1061 NE 91 Terr (10)Application is he :cby 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.
Owner's Name and Address d'1 M-
Registered Architect and /or Engineer a .•.•••..••,.•,••••„••••:,•.,.
Name and address of licensed contractor 4\ \ -\ NE` C '...\�� a Me �,5 CT \A( f,
Location and legal description of lot to be built on
Lot Block / Subdivision I ra=
Street and Number where work is to be done 1 0 CO I
State work to be done and purpose of building (by floors) i . �. r .. \.1...._..___ \. °
60 1. . ..... . .P:L . 0 t o C o- .E
4 -�
• ?` FOR BUILDING PERMIT
and for no other purpose.
New Building.aDS.V.K.6 Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
0
Estimated Total cost of improvements $..: . i3 O O
Zone cubage required ``
Distance to next nearest buildingUi
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 undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida \Vorkmen•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
ntractors, on work to be performed under this
or notices as are required by the Act. The undersigned agrees to employ only such
pennit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA, `
COUNTY OF DADE. j 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. _ _ K
Permit No.._ -Z Date (?1*-- / �'" / u Read, Sworn to and Subscribed before me.
Disapproved /
C r Notary Public, State of Florida
(Signed) • - -• / 0 —
Building Inspecir My Commission Expires
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARIrMENT
"7 — r 7 .
rg.
Date.. —
er
Chairman
Mcrnber
Member ...... _....._..._._ . - -.-
Council Approved Date
NE -
Amount of Permit $,
Plan Cubage
Size of Building Lot
LANNINC BOARD DATE
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is horde necessary by improper notice
materials and /or workmanship.
to me well knowta,
Member
Member
Member
Disapproved Date
has been obtained from
for inspection or faulty