897 NE 91 Terr (12)Estimated :tat cost of improvements $..
Zone - 'ubage required ...
Distance to next nearest building.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
and who, being by nie first d, Iv sworn, upon
of th abov. de gibed istruction t, 1.
therein by him stated are tree.
Permit No._.__ .___ _.. T1 Da
Disapproved _
( Signed)
MIAMI S ES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLSCATO i NCI IF
New Building. — _ Remodeling__ Addition
To be constructed of i`'sC Kind of foundation _.__ v,e
UOL ®ONG EiRIIMOT
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 herci: described. This .application is made in compliance and comorimty with the Building Ordinance of Miai ii
Shores Village, Plor;da, and all pro■ isions of the Laws c f the State of 1' lorida. all o d nances of M an Shores Village- and all iules and
regulations of the Building Divc:.i n of Miami Shot, illage ,h '1 ',e oo, pled with, whether herein specified or not. A copy of approved
plans and specificati:ns must be kej" at building durin, progress of tl.c work.
Date - - - - - -- '7 7 AS
Owner's Name and Address _._ / No q7 Street /. g
Registered Architect and /or Engineer._ / >13. /�d>Q e/C __-
Name and address of licensed contractor ._ �°�CQ_ /.L��C�___ /G'._
Location and le/al description of lot to be built on:
LotJ S'� / /�. �0. ¢d�Block..- - -- Subdivision Q y' - -- - /°�i¢f� s"0A ot1 - - -
Street and Number where work is to be done es _ 7 A/ 9/ `- Z
State work to be done and purpose of building (by floors) r,.J/'-V / -/' / M O - _ "Arse
- --------- _ _____________ _ __ __ __ _ and for no other purpose.
Repairs. _ No. of Stories
C 0' . Roof Covoring _
Amount c ` Permit $.
Flan Cubage
Size of Building
Lot - - -- -- - -- 76 - -- _nid
Maximum live load to be borne by each floor .
hereby submit all the plans and speciiic•ations for said building. All notices with reference to the building and its construction may
sent to.-- --- `ra 176 "1 / / ,•07r/,at: vr! /I�I.�X_ / ��!✓,.
The uncle signed appli• :ant for this building permit does hereby certify ihat he understands and accepts his obligations is an employer
of l: bor under he Florida Workmen's Compensation Act being S •tion 5066, Co: pled Gen al Laws of Florida P r. -anon S vent,
and his complied wqh the pros/ :io thereof, and will require similar cov lance from all contractors or sub - contractor:, cinplo ecl b■ him
in the wo.k to be p ri -med under this permit and kill post or cause to be posted for inspection on the site of the work sit :h public not e
or i•otices as are requn•- d by the Act. The u.cli r•.ign.•d agrees to employ only such : ubcontr. ctors, on work to be perform• d der this
permit as are licensed by M ami Shores N, illage.
Remarks - (Signed)
ti • f I -tiCG�
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ,.nd take acknowledgments, personally .‘p-
peared
to me well known,
oath deposes a d says that he is the ..
\ careially red the foregoing application, and that he did sign the same, and that all :acts
S)
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nissinn Expires. ..
PLA , NING BOARD ?� (f
Chairman .. 11 7 ember
Member .___ . L�_._ .__ _ . _ 11 . Member
Member _ Member
Council Approved _ Date Disapproved Date
NOTE: A charge of $1.00 will be made for snaking corrections er ::hanges to this application 'ft.-r approval 11,s Ise, it obtained n•d from
the Planning Board
A re- inspection fee of 51.00 will be charged when such re- inspection is m: '10 necessary by improper notice NT inspc t•.m or be ty
materials and /or workmanship.