915 NE 91 Terr (8)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
- Application is hereby made for the of the detailed statement us tsie mans and specifications herewith submitted for the build
ing or other structure herein ilcscrtbed. This application Is made in compliance and conformity with the Building Ordinance of Ntiami -
Shores Village. Florida. and all provisions of thc Laws of the State of Florida. all ordinances of Miami Shores Village and idl 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 /Magma of the work.
Owner's Name and Address
Registered Architect and/o ngincer
Nurse and address of licensed contractor
Location and legal deseriptjon pf lot to,9 brOt on:
462.1 ki/LRLY D Subdivision...4 et 1/ ti..zei lig 0
Lot
Street and Number when, work is to be done
State work to be done and purpose of building (by floors)
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0.0 • •
New Building ReznodCling — Addition . Repairs...._
To be constructed of . Kind of foundstion-- — Roof Covering.
7 ll t)
Estimattai Total-cost of improvements $ —Amount of Permit $ 3 i
Zane cubage required Plan Cubage- —
Distance .to next nearest building ..... — --Size of Building Lot
.Maxitnum live load to be borne by each floor
hereby submit all p tns nsp icati s for said builclin All notices referenr to the innIding and its construction may
be sent to.. .....
arm
The un dersigned ! ant for this building permit does hereby certify that he understands and accepts his obligations as an e mployee
oi labor under the Florida Workmen's Compensation Act. being Section 5966. Compiled Ceneral Laws of Florida. Permanent Supplement.
anti has complied with the provisions thereof. and will require s 'lar compliance from all contractors or sub-contractors employed by him
M tl:c work to be performed under this permit; and will post or cause to be posted for inspection on the ' e of the work such public notice
n
or notices as are required by the Act. The undersigned agrees to employ only such su actors, o performed under this
permit. as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me. the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments. personally ap-
peared ..
(Signed) ._—
•••••••■••••••••......
MIAMI SHORES VILLAGE
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
therein by him statecre true..
Permit No. 1/
Date kl OV1
Disapproved ate
Notary Public, State of Florida
— .
My Commission Expires
Member
Connell Approved
Building Inspector
Ciairtnan . —
A charge of $1.00 will be made for
the I'lannint: P.u.ird.
A re-mwection fee of 31.00 will be charged
materials ano/or workinanshtp.
qM
p re# 4. `11P ,
L.*
PLANNINC BOARD
? .19
.Dat.
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fp,
///1-4121 412...14!/
Read. Sworn to and Subscribed before me.
Member
Member
to me well known,
Member
—Date Disapproved —
making corrections or changes to this application after appmval
when such re-inspection is made necessary by Improper notice
and for no other purpose.
No. of Stories........-----
—.
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same, and that all facts
• -
Date
has been obtained from
for inspection or faulty