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1133 NE 91 TerrRegistered Architect and /or Engineer.... Y CS Name : address of licensed contractor Estimated Total cost of improvements $ Mfaxiunum live load to be borne by each floor be sent to.. 1/ A/(' 9/ 71 Building Inspector MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT " /rg Application is hereby made for the approval of the detailed statement tit me plans and specifications herewith submitted troy he build ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance o3 Miami Shores Village, Florida. and nil provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and al? 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. Date..._... " . ..o.a..._._ o... Ilb ) Owners Name and Address .../En .0 i lY1 .. ®......_ ._ No...._).1 -� ...» . Street-0 ° n 1 e As 1' Locatio;, and legal description of lot to be buil // on: �� 4 Block v& fS. / Subdivision £L 6 2): 6 -7 6 —. .. Lot ..... Street an Number where work is to be done. // 'vim ? State work to be done and purpose of building (by floors)..... e 0 06 1,43 • c9 ig24C2t s1t�d'n and for no other purpose. New Building Remodeling Addition Repairi No. of Stories To be constructed of C6S Kind of foundation C© fC2e re_ Roof Covering AZ 621 eje/../2rue : 021? 00• ••..... OtffLYt?flQ! Amount of Permit $L..9L.a. 0 Zone cubage required c plan Cubage Distance •¢o next nearest building. �` 1 - / 0 Size of Building Lot CtS �� AM • PLANNING BOARD DATE Chairman Member Member Member Member .. .. _.....__....._..._.— ....__...... Member Council Approved Date Disapproved 6i £tea Z6 6 I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction rnny 3313 P The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an c•onploy¢y of labor under the Florida \Vorkrnen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sotp plentent, and has complied seitlt 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 th •f the work such ublic notice or notices as arc required by the Act. The undersigned agrees to employ only such , r sabcpntractors, work be performed under this permit, as are licensed by Miami Shores Village. Retnarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, pe nEA. 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 fa : ', therein by him stated are true. . Permit No..__..!!`!.:L.:1 s.fl Date jgi 7 K _- -•- . Read, Sworn to and Subscribed before me. G Disapproved .... Date \ ti (Signed) _Sti`XWO/ Notary Public, State of Florida ' 1 My Commission Expires to rt:e well kaowo, NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been rcbtained from the Plannir•;.: Board. A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for insprstism or fault/ materials and /or workmanship.