1200 NE 91 Terr (7)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed state.rrenr or me 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, ?iorid.r. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Viilagc 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 progreu of the work.
Owner's Name and Address ..... s...M!..L.A. /.0..Ii .. — No../ 4.00 . Street - 442..911
Registered Architect and /or Engineer ,Q
Name and address of licensed contactor Qilitl.Jlirt,Qiair Rail. Le‘ ...__...
Location and gal description of lot to be built on: /�
Lot 2..' Block
Subdivision /�.R.ir ..._.�__
Street and Number where work is to be done /ADP de r.a.. /r c __� �. .M.. ..._._.._ _. —.
S t � 4 ...
State work to be done and purpose of building (by floors)
bast Vj1) 41 -1011
Disapproved `:.. ... J. �_....... Date
(Signed)
Building Inspector My Commission Expires
Notary Public, State of Florida
and for no other purpose.
New Building / .. Remodeling.... .Q... Addition... 4 Repairs' . .... No. of Stories
To be constructed of eai taAGi(tfSind of foundation gV4 if ' !
Estimated Total cost of improvements S....400 Amount of Permit $..t s. •i l'.
oof Covering
Zone cubage required _.._....Plan Cubage ?0*
Distance •to next nearest building. Size of Building Lot.... . .�
Maximum live load to be borne by each floor
I hereby submit all the pl, ns and specifications for said building. ll notices i reference to the building and its construction may
be sent to.. lIV..... e._l.,A• � �. 4 / fir
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, Permanent Supplement,
and has complied scith 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 he site of the work such public notice
or noticcs as are required by the Act. The undersigned agrees to employ only such subcontr y rs work 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-
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 state e true..
Permit No.._.. 5
Date 1 Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Member i►fembcr
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 Plannir,;; Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.