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1165 NE 91 TerrAPPLICATION FOR BUILDING PERMIT Application is hereby wade 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 Honda, 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 Addre''''' `� ���� Registered Architect and /or )yngi;wer MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT C c:N . 1', Name and address of licensed contrpctort4 ;ii Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done if 6— "C - ( 2' 412, _,Al - 4 State work to be done and purpose of building (by floors) .......eeW" 1 t� r' C-t . - • t y_ Ee.'..4c and for no other purpose. New Building Remodeling Addition Permit No.._.. Disapproved (Signed) Date ..G' Date..._...._......._..... .��.�^'f.�= ....�._.,._...._.... ,19�'.::� `?f .6 No..i.... ^.. Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ l (-' "`- 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 Honda 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 pennit, as are licensed by Miami Shores Village. Remarks._._ ' Signed ) Read, Swore to and Subscribed before me. ilding Inspector \ My Commission Expires PLANNING BOARD _ .._ DATE Chairman Member Mermber Member Member ...... Member ..... Council Approved Date Disapproved NOTE: A charge of $1.00 will be made for making correct :0ns or changes to the Planning Board. A re inspection fee of $1.00 will be charged when such re-inspection is made materials and /or workmanship. Notary Public, State of Florida 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. Date this application after approval has been obtained fmm necessary by improper notice for inspection or faultv 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 at building during progress of the work. Owner's Name and Address . .. P`f 41'4' R., Registered Architect and /or Engineer Name and address of licensed contractor CA-1 f" 52 (4, o. Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors)... et i*r e sa... t. . f, tl4 L!)r " j+ IV and for no other purpose. Repairs No. of Stories New Building Remodeling Addition To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ , `•. Amount of Permit S. 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, Perm.rnent 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 subcsintractors, o work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) Remarks STATE OF FLORIDA, COUNTY OF DADE. Permit No.__.._._! �! v Disapproved (Signed) ss. l Date. Building' Inspector Date 1 PLAN NC BOARD DATE Chairman / Member Mfcrr.ber Member Member ...... Member Council Approved Date Disapproved Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires 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. Date as been obtained from NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval h the Planning hoard. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection oe faulty materials and /or workmanship.