953 NE 91 Terr (6)t
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Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Street and Number where. work is to be done
Disapproved ate
(Signed)
Chair ;nan
Mcrr,ber
Member ..
Council Approved Date
ESU OG '6 /t/
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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3
0 3 O Oefo7
APPLICATION FOR BUILDING PERMIT z/3i
Application is hereby mode for the approval of the detailed state...cnr or me plans and specifications herewith submitted for the build
inc or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and nII 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 buildir}S during pro rest of the work.
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�/`� 4 — No. / q -5-3 Streets r' zf y/ r6 /'.
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Date
Location and legal description of lot to be built on:
Lot Block Subdivision
State work to be done and purpose of building (by floors) i "5 r/ ! 2
PLANNING BOARD DATE
A - )ooD
Notary Public, State of Florida
,
and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation f Covering _
Estimated Total cost of improvements $ L3600° ov Amount of Permit $. g
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.. °? 4 400 £' U `r7 I
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 Snp clement,
and has complied sm ith 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signe
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
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.._._._ -C ? Date L . 3 Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
Member
Member
Member _.._.....
Disapproved Date
NOTE: A ch.corgc of $1.00 will be made for making corrections or changes to this application after approval has hero obtained Imin
the Pl inning
A rc- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.