1200 NE 91 Terr (3)Owner's Name and Address L[ t L 4' r/4'€4
Registered Architect and /or Engineer V (/.) / itt '-
Name and address of licensed contractor O' i✓E - Ad
Location and legal descript'on of lot
.2� L w is ' 3s
Lot BlA
ilt on:
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
7;7 cif
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
Subdivision
and Number where work is to be done / DO ,4/ L 9(
Date � ,t r 19,7
No. ff Street
// // Qq1 S
State work to be done and purpose of building (by floors), state exterior colors (submit samples) /� ��
C;CDS� ta��
s-- D0/9/t— 4/' airrvc;eoc 9R- ESL\ 44
ti 11111V.
rt ! a ..
and for no other purpose.
New Building Remodeling Addition Repairs No of Stories /
To be constructed of reetfC it- r *Ck Itind of foundation P rile-: Roof Covering `
Estimated Total cost of improvements S 3 PI- Amount of Permit S '1 n 5k
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 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 obligatons 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 empl. o subcontractors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed —././://:410
STATE OF FLORIDA
COUNTY OF DADE. }ss.
Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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
Permit No.
Disapproved " � 9 Date
(Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials andior workmanship.
Name and address of licensed contractor
To be constructed of
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 building 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 /4A L • L A 114A P n
Registered Architect and/or Engineer -V' P»
-"in A K/
Location and legal description of lot to be built on:
` Ili �/ o� • Lot �/h /,{/ Block ? Subdivision ?/ l // ��4 ®/ 4
W YG J,D ,A/( 4 7 L4 •
Street and Number where work is to be done /
c,S Q'C.1<ti1t'Y NO 764.3
State work to be done and purpose of b ilding (by floors), state exterio,colors (submit s es)
/ and for no other purpose.
New Building odeling ✓ Addition Repairs No. of Stories
Kind of foundation et/
i t -'
Estimated Total cost of improvements S -M Amount f Permit S 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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to
L), 9 0r A/ 9 A-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 .ost 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 s bcontractors. 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 appeared
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 f.regoing application, and that he did sign the same. and that all facts therein by him stated are true.
Date
t�
Roof Covering
Read, Sworn to and Subscribed before me.
Date /d 197
No. [/42 O Street __
Permit No.
:::'°' ed l' 0 / Date
l
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
TOTE: A charge of 825.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
a-inspection fee of 825.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.
Notary Public, State of Florida