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848 NE 91 Terr (6)Owner's Name and Address_ MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Location and legal description of lot to be ilt on: Lot__ __ - Block ____Subdivision Street and Number where work is to be done_ t 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. 4 ez. " 7 , 19 No Street Registered Architect and /or, ngineer____,Agr11 Name and address of licensed contractor ` 4 ` e State work to be done and purpose of building (by floors) and for no other purpose. New Building I' , Remodeling Addition Repairs No. of Stories To be constructed of e �.JJ ___s' Kind of foundation Roof Coveripg / U I/ Estimated Total cost of improvements $ / �' �1 a Amount of Permit $ Zone cubage required / v . �� ' _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 5966, 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 wor • be erformed under this permit, as are licensed by Miami Shores Village. Remarks ( Signed )_ STATE OF FLORIDA, 1 COUNTY OF DADE. i ss. Before me, the undersigned authority a notary public, duly authorized to administer oaths and take acknowledgments, personally al)- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the 7) of the 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. ' C Permit No. �? � Date //'''';' // ' (' r -) Disapproved Date a �e (Signed) My Com fission Expires �'LANNING BOARD // -6' ___7 DAT Chairm 40 - -- Mem r Memb:� !% � I , ' �� —� Member Member // _ '7 _' 1 /�0 _ _ `r _ : ► D �i Member Council Ap•ro e. 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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or fault - 'qls and /or workmanship. Building Inspec r r di 19 ,�' •' -' ' K Read, Sworn to and Subscribed before me._ Notary Public, State of Florida i, • .r Lot - r Flock ) ,Subdivision No. Street Q Ar \I , t/ i> i if (J iOwner's � t .l /�° 7 o -- General Contractor Zone Req.Cu.Ft. / A 06 Cu.Cont To Planning Board vl" // � Approved � Rejected Re- Submitted to P.B. / Approved Rejected � / /1, C Plat Restriction Checked by Plans & Spec. Checked by To Council Bldg. Permit No. (Date Type (, , f New Construction Building Inspection Foundation Beams & Lintels Final Final Clean -Up Septic Tank Solar Heater Final Certificate Misc tl 11 II New Const. Alteration Repairs Electrical Permit No. /7C-70 Date (/yFee F ix tures _ a Heater gap/ ez it lei " Miscfl r " • New Construction Alteration Stories Plumbing Permit No. &rte L.. " Date Fee Septic Tank ,$' 7/7',5/41C Sewer 11 I � Plumbing Inspection Dat© By Re -lisp By Re -Insp By Roughing � � ) 4-`a r/r_ 6(/ Fixtures i7S I Sower u d i Electrical Inspec£nn D to By Ploughing (/ / I/ s' %A Fixtures / �, / I7 25 Final memo. O.K. ri 0 /,,n! //I ages / ,0 (r7' gz/ Lic.No. Lic.No. Approved Rejected a - " te a Fee Cost /0 0 0 ( 0 Roof / / // Alterations Repairs D- e By Re -insp By Re -Insp By Add. or Phone Add. or Phone / By 1t 1r Repairs -insp By Re -Insp By ervic© O.K. to Power Co . GYT/ 33 7 Cert.Occup.Issued 7 777Me