901 NE 91 Terr (4)Registered Architect and /or Engineer
Name and address of licensed contactor
MIAMI SHINRES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR +=UIL®INO ERMIIT
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.
7`
Date _ q _ / ... .... ,19
Owner s Name and Address C , 42 L e= S T 1 E' - / A G v No Street - ! 0 /L. C 9 "-"
PLA
R 4 -- / E A/Ce eO ao x - /
Location and legal description o lot to be b ilt on: LL
Lot " E iN ? Rd ' Bl.oc�kka / 7 Subdivision " / S C n -C -'
Street and Number where work is to be done 9 A/ ' o - - -
State work to be one and purpose of buildin (by oors)- -
gnd 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 $.
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 budding permit does hereby certify that he understands and accepts his obligations as an employer
of labor under theFlorida 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 subcontracto :, . . k to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA, 3 . Box 4033
COUNTY OF DADE. SS. a15 /ear . [1�0 ao "
E, �ltS
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
NINC BOARD
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. a"'
Permit No..__.___. 1 - 3 Date ., Read, Sworn to and Subscribed before me.
Disapproved Date.___ -_ .. i
"III
p _ �� f Notary Public, State of Florida
(Signed) G - -..
Buil ing Inspector My Commission Expires
DATE
31/a
to me well known,
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 nfter approval has been obtained from
the P Board.
A re 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.
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P. O. BOX 4832 • HIALEAH, FLA. 33014
FENCE CO.
7rC W. 29 ST. HIALEAH, FLA. 33012
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885 -7957
823 -3755