1225 NE 91 Terr (3)Disapproved __- _ D,te__
( Signed) -
Chairman ..
Member ___ _______
Member ._.
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR RMIT
, �� 6c NJ C..
Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the builu-
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.
Date Nov._.. , 19__.69
Owner's Name and Address
E. M. Lenza No 1 2 2 ? Street - N,E,___91st h Terr
Registered Architect and /or Engineer
Name and address of licensed contractor_._ Browning_ Sept o_ Tank __ServiCQ --44$$__ 10th Co _ _Hi
Location and legal description of lot to be built on:
Lot__ Block Subdivision
Street and Number where work is to be done 12 2.5 __j1j,___$,.__9],st
State work to be done and purpose of building (by floors) re place ___o1dtBeptic__tank._with..900 _gallo 71..tank
of 75 drainfieId. _. Flop and abandon old tanlc
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $ $4.00 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 Workmen's Compensation Act, being Section 5968, 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 employ only such subcontractors, on 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 stated are true.
Permit No.___11L_V Date____ t - 1 1 - - L'1 _ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Build g Inspector My Commission Expires__
PLANNING BOARD__ .. _ DATE
Member
Member
- Member
_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 Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.