1084 NE 91 Terr (8)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING [PERMIT
Application is hereby made for the approval of the detailed statei.uirn 01 die plans and specifications herewith submitted for the build
in or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and n11 provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules nd
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.
Date ...—...--a •..2 •■•••■•••{20.•=1M•• ••••• •■•• .91. ••■••••• • • 0 11:
Oer's Name and Addre
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Registered Architect and/or Enginee
Name and address of licensed contractor weaa.
Location and legal description of lot to be built on:
Lot Block Subdivision •■•••■•••••■•■■••■••••■•••■•
Street and Number where work is to be done.../ 6 R --- V A F..rr ? LL '?L r .. .. —
State work to be done and purpose of building (by floors) _
eLgE.A ..e...ce
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and for no other purpose.
New Building Remodeling Addition Repairs - of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 4,<-2 0 0' Amount of Permit
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 my
be sent to..
The undersigned applicant for this building persnit does hereby certify that he understands and accepts his obligations as an employe.?
oi labor under the Florida ‘1'orkinen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Stipplement,
and has complied u ith 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 inspectio on the site of th work such public notice
or notices as are required hy the Act. The undersigned agrees to employ only such su • s, on wor t. , r,o d der this pennit, pennit, as are licensed by Miami Shores Village.
Remarks (Signed
flfl 91 ... e . "17,1711"71,1•9919111
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, notary public, duly authorized to administer oaths and take acknowledgments, peobooally ap
peared
--....to Fee well keovsla
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 artrue..
Permit No
•/,
Date . Read, Sworn to and Subscribed before me.
Disapproved Date
\. • 71" Notary Public, State of Florida
(Signed)
My Commission Expires
Building Inspector
PLANNING BOARD DATE
Chairman Member —
Nlerriber Member — —
Member — — Member
Council Approved Date Disapproved Date
NOTE: A charge of 51.00 will be made for making corrections or changes to this application after approval has been Obtain limn
the Plannio.g Board.
A re-in fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection
materials and/or workinanship.
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