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1213 NE 93 St (3)ov MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement or ore 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 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. Owners Name and Address . Street.__.3 _ __ _ Registered Architect and /or Engineer sr:,. n••• •t.t• ttetwa.trw,•t•„r„n,ewt:tt. Name and address of licensed contractor. (5e 4. a?e•AAVIALi. .. 11 .5. flu) 12 Que. • 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 purposc of building (by floors)..... ...p.(QQ +0 .E.gralfzh. a...\ ci awn . I.Cf 2 / and for no other purpose. New Building Remodeling y Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit s.. ..Q_.G R. Zone cubage required Plan Cubage Distance • to next nearest building Size of Building Lot Maximum live load to be bome 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.. sass ... 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 nt Sup dement, and has complied with 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 are required by the Act. The undersigned agrees to employ only such bcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. - Remarks (Signed STATE OF FLORIDA, COUNTY OF DADE. I ss ' Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared - 11202) LS R. V QtI R and who. being by me first duly sworn, upon oath deposes and says that he is the. ...F1.f"LI.0....0cv.I NlKA- 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. a1, Disapproved (Signed) Date .3 \ . 1 .�+ Date — WO Building Inspector 1 213 E .. �. _ ...�.._ �._ Read My worn to and Subscribed before me. Notary Public, State of Flonda NOt,ott 'UdL �- �i -!.)ttiOA At L KU Commiuion Expire .C,OWAISS1Ctst.1XP.IRES.A111.a B3.— BONDED THRU GENERAL t NS . UNGERWRI TERI PLANNING BOARD DATE Member Member Member �.._._.... to me well known, Chairman 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 Plannir.;.: Board. A re- inspection fee of 51.00 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 approyal of the detailed statement of the plans and specifications herewith submitted for the build- 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. Date.. Kt.1 , % /- 19 Owner's Name and Address � Z9L � � No. _I,_1_ Street_ 1'■ - ' C t a. ACV Name and address of licensed contractor Registered Architect and /or Engineer Location and legal description of lot to be built on: Lot 3 Block 1 Subdivision f Vic.. %A - 1 C , ___ Street and Number where work is to be done , k3 K, . q3 ' _ \ !.k_a �.1_ k _ _ State work to be done and purpose of building (by floors)____.. C;OQltc0 — e N:>aNQ c c CCO, Pc: ,il , IQ __ - .Q and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ - 00.0 Amount of Permit $ e) 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 accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled G- •ral Laws of Florida, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from ntractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted f. i • ite of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub :ntr. tors 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 acknowledgments, personally ap- peared 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 y 7' � a ate 1/ Read, Sworn to and Subscribed before me. Disapproved Date (Signed) APPLICATION FOR BUILDING PERMIT 1 MI MI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Bui ding Inspector Chainnan Member Member Council Approved PLA G BOARD DATE h6'( LuRt to me well known, Notary Public, State of Florida My Commission Expires Member Member Member 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and workmanship.