1051 NE 93 St (13)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
State work to be done and purpose of building (by floors)
Disapproved Date
(Signed)
Building Inspector
MIAMI SHEIFiESVILLAGE:
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDINI3 PERMIT
.,)plication is hereby made for the approval of the detailed statement of the plans and specifications her:with submitted for the bHId
r other structure herein described. This application is made in compliance and conformity with the Building Ordinance of NI iam
_es Village, Florida, and all provisions of the Laws of the State of 1 all ordinances of Miami Shores Village and all rules ;tlir
....g,ulatior.s of the Building Divis;on of Miami Shores Village shill be complied with, whether herein specific d or not. A copy of appr ■vi
plans and specifications must be kept at building during progress of the work.
Date _
Owner's Name and Address
No Street
Registered Architect and/or Engineer
, 19
and for no other pur ?ose.
New Bur ding 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__
Maxiinurn live load to be borne by each floor
T. 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 his obligations as an c:nploycr
of labor under the Flcrida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require s milar compliance from all contractors or sub-contractors employed by ]ii
in the well: to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public retie.:
or notices as arc required by the Act. The undersigned agrees to zmploy only such subcontractors, on work to be 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 acnowledgracnts, 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 describec. construction, that he has carefully read tie foregoing application, and that he did sign the same, and that all fac:.s
therein by him stated are true.
Permit No _________ ___________________ Date Read, Sworn to and Subscribed before me.
Notary Public, St lie of Florida
My Commission Expires
PLANNING BOARD. DATE
Chairman ____ Member
Member Member
7);t• e
Member .... .... ___ Member _____ — ______ ---
Council Approved _ . Date Disapproved
V .
(.5EJ A =Ic
rge of $1.00 will be made for ing correcdons or changes to this application after approval has bccn n7)i ( . 1 - n
iri, n
material all‘'''' ' - is made necessary by improper notice for inspection or :atilt},