958 NE 91 Terr (10)APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of the plans and specifications here - with submitted for tk:
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.
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Owner's Name and Address a � Y ` ; � �, u No . n i Street
-----��.
Registered Architect and /or Engineer U 4 -
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot ; o `'� ;9>" Block C7 t.22
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Street and Number where work is to be done 11 q', „
State work to be done and purpose of building (by floors)
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n rii C
Subdivision__ �
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Date _ � l 1 ` _) , Il0
M � � � 0.•2111 fl!�l, .,� ,o \N:;: : ; i
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- - - - -- - r � � �_ �L and for no other purpose.
New Building Remodeling Additio X',:,_ Repairs No. of Stories .,,_
Estimated Total cost of improvements Kind of foundation �� Roof Covering ' "
To be constructed of___._o__,—' ^ �_ -- / - 1
provements $____ � 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
II 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 accepts„h-ir,obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Generalaws
ctors
•
Disapproved
(Signed) �" r
Building Inspector
Notary Public, State of Florida
IoridA, Permanent Supplement,
r sub - contractors employed by him
e site of t e work such public notice
n work t97 be performed under this
and has complied with the provisions thereof, and will require similar compliance from all con
in the work to be performed under this permit; and will post or cause to be posted for inspe
or notices as are required by the Act. The undersigned agrees to employ only such subco
permit, as are licensed by Miami Shores Village.
Remarks (Signed) tii'0 _!: % ,
STATE OF FLORIDA,
COUNTY OF DADE. f ss•
Before me, the undersigned authority, a notary public, duly authorized to administer oaths aid ke acknowledgments, personally ap-
peered
___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 N o.___� ?_ Date / Read, Sworn to and Subscribed before me.
My Commission Expires
PLANNING BOARD DATE
Cha%inan 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 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.