1200 NE 91 Terr (4)Application is hereby made for the approval of the detailed statcuncur ur tore plans and specifications herewith submitted for the build
inc 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.
p i Date... i •� —12 _ i . 119
Owners Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location an legal descJ do of ?t o be built on:
Lot S ki//S IG731 oc
peared
Street and Number where work is to be done
State work to be done and purpose of building (by floors)..
New Building
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Subdivision....
! �Q.... a C. • v-/ !L
Remodeling Addition
To be constructed of . M. Kind of foundation Roof
Estimate Total cost of improvements $
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 ‘Vorkrncn's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Snp pleurent,
anti has complied w ith 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 site of the work Such public notice
or noticcs as arc required by the Act. The undersigned agrees to employ only such subcontractors, grvt�ork to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j ss'
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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
� ^ ttrue..
Permit No..__.... Date Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
nn
,,,. ,,.•••...•....<.• n „
'3 1
r•.•,,.,,. z
Amount of Permit S. 1 5 v
Notary Public, State of Florida
My Commission Expires
and for no other purpose.
Repair*
No. of Stories _
to me well known,
PLANNING BOARD DATE
Chairman Member _
Mcrr,ber 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 PLrnnir.g Board.
A re-inspection Ice of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials anti /or workmanship.