1131 NE 91 Terr (13)APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed stateiiient in me 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 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 Of not. A copy of approved
plans and specifications must bc kept at building during progress of the work.
Owner's Name and Address \ \ .'\ ME • n l. .... No.-- . . —.. Street--
Registered Architect and/or Engineer 1:1 • M ••111•ITIITOTTIPF99,•49, 99999 C•771:
Name and address of licensed contractor...L.(11r 16 '' .S 0 k
, 2 —
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done...‘.. .. .... ... :_ • - e l \
_ • .,•,.
vt;4) ea.A) "LA•Cy•c 0 -Y4i ... _ ‘,A. L? j !, i i -
State work to be done and putpose of building (by floors).. , k ■-. -
....—S:11 1, — kl
— and for no other purpese.
Ncw Bui!ding Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation v . Roof Covering
\ fi '`, . ........... ....... --
Estimated Total cost of improvements $ ''.DS) Amount of Permit
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Disapproved Date
(Signed)
Building Inspector
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 per:nit does hercby certify that he understands and accepts his obligations as an employer
of labor under the Florida \Vorkilien's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sumdement,
and has complied .‘ith the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him
in the work to bc 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 ubcontractors, n work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persena4 ap-
peared
re
mom,
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 a refu1Iy read the foregoing application, and that he did sign the same, and that ail facts
therein by him stated are true.
VZ,t) ce0
Permit No.. _&2_ Date Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
MANNING 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 obtaineci from
the Plannire; Board.
A re-inTection fce of S1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials anti/or workmanship.
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