1990 PAINT 770 NE 91 STOwner's Name and Address /'7/44
Registered Architect andlor Engineer
Name and address of licensed contractor
Street and Number where work is to be done
APPLICATION FOR BUILDING PERMIT
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 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.
L a d legal description of lot, b�bu t on:
Lot 114-- Block Subdivision /95 s [3 L) e7
77e A1 e" 9 / Sfi
State work to be done and purpose of building by floors). state exterior colors (submit samples) (k /h/ / At ( EjCT6/11 aft? D
aLO4'. 5;9 Ale 0re7dre !✓N /rt Z41 / AQvi TR / 44
// P.n.) and for no other purpose
New Building Remodeling Addition Repairs T No. of Stories
To be constructed of Kind of foundation Roof Covering
sr `C/t�
Estimated Total cost of improvements S /�0 ~ Amount of Permit S
Zone cubage required � Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
1 hereby submit all 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 obligatons as an employer of Labor under the Florida Workmen's
Compensation Act. being Section 5966, Compiled General Laws of Florida. Permanent Supplement. 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 agree • o only such subcontrac • •n work to be performed
under this permit. as are licensed by Miami Shores Village.
Remarks (Sign
STATE OF FLORIDA
! COUNTY OF DADE. } ss.
Before me, the undersigned authority. a notary public. d d uly` authorized to administer oaths and take acknowledgments. personally appeared
H
and who. being by me first duly sworn, upon oath deposes and says that he is the cLes t(leak
of the above described ' construction, that he has carefully read the foregoin_• application. and that he did sign the same. and that all facts therein by -him stated are True
co .
Permit No. / 0 ' Date / - Read, wor to and Subscribed before e
(}C1 t ti c iu Date � _ .._. � zai` ee Notg/PtkcpLSt�tetof Y.. FLORID9:o-
Disapproved
(Signed) l 'YL- MY COidh lS�i ?: EXPI: S AUG. 6. 19
My Commission Expires aoNCZo THRU NC. PUBLIC UNOC•RWRIT Rte
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
.� Date
Si/o•CL 4 K . O e QPrS
JAtftri KG CelLy
Ovf°
19
770 Street t :
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tb me well known.
PLANNING BOARD DATE
Chairman Member
Member Mernber
Member Member
Council Approved 1 ate Disapproved Date
NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and:or workmanship.
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