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1130 NE 91 Terr (3)MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby 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 a'. building during progress of the work. Owner's Name and Address- .... _ ✓.. ✓ " = No / Street Registered Architect and /or Engineer Name and address of licensed contractor__ Location and legal description of lot to be built on: Lot. u° Block 2 Subdivision._ Street and Number where work is to be done Date i , 19 State work to be done and purpose of building (by floors) Building Inspector My Commission Expires and for no other purpose. Ne,v F,nildi ng Remodeling Addition Repairs No. of Stories To he constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 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 % 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 permit 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 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 are 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 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, and that all facts therein by him stated are,true. Permit No Date... Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) 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 after approval has been obtained from 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. (%) Torv- 72 •••D Trk-1\ a:4 (7 „ yL. — t-t 9 as4 z 4 q. c .. 2 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other strut ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Villag Florida, and all provisions of the Law of the State of Floi •da, 311 ordPnances of Miami Shores Village -nd all rules and regulations of the Building Division of Miam Shores Village sh, 11 be co _,plied with whether h -r _ in specifie ' not. A cop of apt row d plans and specifications must be kept at build.ng during progress of the work. Owners Name and Address -_ Registered Architect and /or Engineer._ COW a Ebel 0 Le 0 Q Name and address of licensed contractor __ Location and legal description of lot to be built on: Lot Block _ --- - --- --. -.--- __ -- -- __- - -- Subdivision Street and Number where work is to be done-- ---��_` ___ � 1l_� LS -' -- --- .-- -- - - -- -- - - - - State wok to be done and purpose of building (by floors)__ & __ c1. -- 1 - gg P_ - - - -fit and for no other purpose. New Building__________ ____ __ _ _ .._ Remodeling Addition Repairs _ No. of Stories To be constructed of- _.__._ _ .___ Kind of foundation - Roof Covering H i - "; Estimated Total cost of improvements 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 may be sent to The undersigned applicant for this building permit 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 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 poste for inspection on the site of the wor such public notice or notices as are required by the Act. The undersigned agrees to employ only suc subcon tors, on wi be f rformed under this permit, as are licensed by Miami Shores Village. Remarks - -- (Signed) STATE OF FLORIDA, p 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._` Disapproved (Signed) Chairman Member Member M Building In `sector AM SHORES VILLAGE UILDI NG INSPECTION DfPA 'T? T ENT A P =8C . TIDN FOR RUILDINO PEA IT Mum A.1.5 Date le - Dat. _ No.. 8Q LANNING BOARD . . __ DATE Member Member Member Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires ___ Street_ _ TQ_ _ __ to me well known, Council Approved ._. Date Disapproved _ ._ ___ Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after appr ., i has been obtained from 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.