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860 NE 91 Terr (9)Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regula- tions 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 Registered Architect and /or Engineer______ Name and address of licensed contractor Location and legal description of lot to be built on: Lot______—_________ Block__ — ____ ___ Subdivision !' Street and Number where work is to be done State work to be done and purpose of building (by floors) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Building Inspector My Commission Expires_ / // Date___________ ____ —_ ��— — — 19 ___-- No Screet___ - -�_�� i __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 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 reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that be 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 work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 be did sign the same, and that all facts therein by him stated are true. Permit No—__________________ Date Read, Sworn to and Subscribed before me. Disapproved — ___— ____ ________ —___ Date__ (Signed) Notary Public, State of Florida PLANNING BOARD DATE Chairman Member _ Member Member - Member Member Council Approved Date Disapproved to me well known, 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 faulty materials and /or workmanship. ___Date BUILDING INSPECTION DEPARTMENT a APPLICATION FORnBUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regula- tions 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 bui }ding during progress of the work. o ` ' /' - Date_ , 19___ A Owner's Name and Address i = : � _ , -. _ No._____ —___ Street— __—_ ___,_ Registered Architect and /or Engineer___ Name and address of licensed contractor MIAMI SHORES VI LLAG E %/1 Location and legal description of lot to be built on: Lot__ Block_____ _ __ __ Subdivision . Irk Street and Number where work is to be done State work to be done and purpose of building (by floors) G New Building_ p / > _and for no other purpose. Remodeling Addition_________ Repairs No. of Stories__ Roof Covering To be constructed of_________________ Kind of foundation Estimated Total cost of improvements �____ -�_:- _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 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 work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) _ STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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. Date Read, Sworn to and Subscribed before me. Disapproved _— — _ — _ _____ Date (Signed) Building Inspector My Commission Expires Notary Public, State of Florida PLANNING BOARD DATE Chairman Member Member Member 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 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 faulty materials and /or workmanship.