1205 NE 91 Terr (8)STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No. ___
Disapproved
(Signed)
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 stru ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Villag -, Fonda, and all provisions of the Law of the State of Floi da all ordhnances of Miami Shores Village -nd all rules and
regulations of the Building Division of Miam Shores Village sh 11 be co _,plied with whether h r in specifie•' not. A cop of apt rov' d
plans and specifications must be kept at buid ng during progress of the work.
Oc.
Owners Name and Address _ �>:s o r o 1 1 i
- -- - - - - -- - - - -- -- -- - - -- --
Registered Architect andk: Engineer
Nance and address of licensed contractor __ _G C O L✓ 2 ___O b E3 f] O LI
Location and legal description of lot to be built o
Lot Block _ __ _ _. _ _ __ Subdivision
Street and Number where work is to be don
State work to be done and purpose of building oors) ____
New Building Remodeling Addition_
To be constructed of _ _ - . _ __ Kind of foundation_ __ . ___ ____ _ _ Roof Covering_ _40_- cz 0 __C: '.Ea r
Estimated Total cost of improvements $1_75, n n _ __ . ._ _ __ _____ ___Amount of Permit $ • r
� 4 fl
4735 g o f G
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 employ °r
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the rovisions 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
permit, as are licensed by Miami Shores Village.
Remarks ( Signed)" �? �/✓s..,
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per o rally ap-
peared - - -- - - - - --
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_
Dat
7 L . _�
Building Inspect r
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Chairman
Member
Member _ _ _ -- _ _
Council Approved . .
NOTE: A charge of $1.00 will be made for
the Planning Board
A re- inspection Fee of $1.00 will be charged
materials and /or workmanship
1205 N_ _„ 91st, TPyb IcE — Giiam1 _ Fl.cri Uu
NNING BOARD
- Date
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member __
Member _
Member __ _ ._
Disapproved _
Da_ - - Ray 179_1966_ 19 --
__ N o. 8020 N i mshnrn
5Uns In( , 7352 N
Repairs
ieA
_ DATE
and for no other purpose.
No. of Stories __ _ _ ?
... . to me well known,
making corrections or change, to this application after appr , I has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
_ _ Date