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934 NE 91 Terr (10)MIAMI SHORES VILLAGE BUILDING INSPECTION D,4R'L1IIfll APPLICATION FOR I3UILDING PERMIT W 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 specifigd or not. A copy of approved plans and specifications must be kept at building during progress of the work. Datel– ___ - ______________ - 19 4/ yam. Owner's Name and Address __ C'i__/ 1/ f / t r' Id- ! No. e4 - StreetLY'C�1/ Registered Architect and /or Engineer "'%or ? ! 9l e __.i + Name and address of licensed contractor ht n C. ? '' -' -,/ Location and legal description of lot to be built on: Lot_ Block _ Subdivision t_, Street and Number where work is to be done I - /e b. 9L ( State worl to be done and purpose of building (by floors) LC" R = . a S..tt ,'./_-_ cJ1> e ej,j 7i dr —� _and for no other purpose. New Building____________ ____ ______ Remodeling ___ Addition —_— Repairs No. of Stories To be constructed of_ Kind of foundation Aof sax-- Estimated Total cost of improvements $ _ Atnount of Permit $____ Zone cubage required— Plan Cubage Distance to next nearest building Six 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 accep of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws and has complied with the provisions thereof, and will require similar compliance from all contractors or in the work to be performed under this permit; and will post or cause to be posted for in ection on the or notices as are required by the Act. The undersigned agrees to employ only such tractors, on w permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, 1 COUNTY OF DADE. Permit No Disapproved (Signed) Council Approved* Date Building Inspector Covering_ 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 he did sign the same, and that all facts therein by him stated are ire. ! > Read, Sworn to and Subscribed before My Commission Expires obligations as an employer rida, Permanent Supplement, - contractors employed by him of the work such public notice to be performed under this me. Notary Public, State of Florida PLANNING BOARD DATE Chairman Member Member Member Member Member Date ;Disapproved to me well known, NOTE: A charge of $1.00 will be made for making corrections cr 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. 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 specifid or not. A copy of approved plans and specifications must be kept at building during progress of the work. � � ▪ ' �"� Date________ / _W__ � ______�__ t 19�W: Owner's Name and Address G._ wi ' t / _�_Q �; r'''.11-... No._!__�? _'�!r _ Street✓Y _ ___r t:___ Registered Architect and /or Engineer ______122.- . /1 e � .�.— 4 17 <: I1 e. 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______ _________ _____,:Y_" _+L • L1___ `�_____________�__ State work to be done and purpose of building (by floors) _J �„_t'► C. lJL .r ICS= and for no other purpose. New Building_________________ Remodeling________________ Addition Repairs No. of To be constructed Kind of foundation___ oof Estimated Total cost of improvements $ r 4__ Amount of Permit 5____ ' 0 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 accep of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws 4f and has complied with the provisions thereof, and will require similar I:ompliance from all contractors or in the work to be performed under this permit: and will post or cause co be posted for in .ection on the or notices as are required by the Act. The undersigned agrees to employ only such § *co tractors, on w permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. and who, being by me first duly sworn, upon oath deposes and says that be is the of the above described construction, that he has carefully read the foregoing application, therein by him stated are t e. Permit No. Disapproved (Signed) Council Approved__ BUILDING INSPECTION DEPARTMENT APPLICATION FOR I3UILDING PERMIT - Date Building Inspector MIAMI S H O RIES VILLAGE 1 L Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take appeared and that be did sign Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires Covering_ 0 PLANNING BOARD DATE Chairman Member Member Member Member Member Date Disapproved obligations as an employer rida, Permanent Supplement, - contractors employed by him of the work such public notice to be performed under this acknowledgments, personally to me well known, the same, and that all facts 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.