1275 NE 93 St (12)i
Distance to next nearest building .gO
Disapproved
(Signed)
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement ur u e plans and specifications herewith submitted for the build •
roll or other structure herein described. This application is mark 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.
Owner's Name and Address . ..IL, I�, t�•, _).et. ittelyo
Registered Architect and /or Engineer ..G✓/9 4-.ttl'.. tit /.......47/.9t tt:.E.rr.. ..1r4e ..,.,,.,,,,,
Name and address of licensed contractortY, Q ,� Z m!t� , t 4
Location and legal description of lot to be built on: /n �'` /'
Lot l Block / n Subdivision.. /.. Y_.fQ.s 44 PE CQcedi/.Ty
Street and Number where work is to be done.. / . Z.. .i t.s- ..x.93. „Cr: ? `...
State work to be done and purpose of building (by floors )..I /peiti.Z n .L elogozz.7 0 6• - -/,' d:C.eQ> .�..11Q.ekeet,
and for no other purpose.
New Building Remodeling Addition...., Repairs No. of Stories
To be constructed of "14. 4.YI ind of foundation.... ../.4/4/ ar Roof Covering C . ... 7. -E
Estimated Total cost of improvements $ . Amount of Permit S....i.i ' /5 ,
Zone cubage required Plan Cubage..1104i0
Size of Building Lot....7
Maximum live load to be borne by each floor vQL.. , _
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.. . . /2-.7.5 . / ./T/ C. ?3 S7 3,3/ Ze
The unite si .c 1 .p scant for this building permit does hereby certify that he understands and accept . igatio is an employer
of Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Ce• al td. f'rn •nt Sup ileyient,
anti has complied %,ith the ,revisions thereof, and will require similar compliance from all • tract• �•7 y�act mployed by him
in the wort: to be performed under this permit; and will post or cause to be posted for in •ion • i o.o • such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such su• • aeto . rform d under this
pennit, as are licensed by Miami Shores Village.
Rein.uks , (Signed)
Date Oar _ 6 ,,
Notary Public, State of Florida
My Commission Expires
r ... ----- -
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, sd that all facts
therein by him stated are true.
Permit No &tb Date P'1 Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Member , Member i
Member .. .. Member ...._ ................_— .._..., �..�
Council Approved Date Disapproved , Date
NOTE: A ch.irge of $1.00 will be made for making corrections or changes to this application after approval has been obtained (mm
the Yl.u,rtih;t I;o.ird.
A re•inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or fr4lty
materials and/or workmanship.