1205 NE 91 Terr (7)Rem:uks..._
Disapproved Date.
(Signed)
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 . \d /e! !
Registered Architect and /or Engineer.... f .1.!l. !`a /
Name and address of licensed contractor.... Z.. i1_..$ Lt :. ..l..i%.. — ..C.6:s c:.2.
Location and legal description of lot to be built or.:
Lot ..2 ? "/ 2 ( Block Subdivision /1".
Street and Number where work is to be done / 2 C'
State work to be done and purpose of building (by floors) l .1 - .._.._ _. ..
Buildin nspector
r,- Noss --..''. - y...__ Street.../2.4 _7 (
_ .__.... and for no other purpose.
New Building Remodeling Addit or Repairs No. of Stories
To be constructed of 1 //e T Kind of founda:ior . 4o erjng
Estimated Total cost of improvements $ 7 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 zeference to the building and its construction may
be sent to.. _
The undersigned applicant for this building permit does hereb;. 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 with the provisions thereof, and will. require similar compliance from ell 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 ender this
pennit, as are licensed by Miami Shores Village. � J
( Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notezy 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 thejoregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
'!
Permit No.. -) Date Read, Sworn to end Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLA e INC 3OARD DATE
Chairman Member
Member Member
Member .. ... - -...._ Member ...._...
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections ae changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re-inspection is rnade neceaury by improper na "ice for inspection or faulty
materials and /or workmanship.