30 NE 93 St (4)APPLICATION F® LIILDIN( E E
Application is hereby made for the approval 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
S:�ores 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 her in specified or, not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Cwner's Name and Address.. / ll ll t, Date f , 19
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Registered Architect and/or Engineer .....
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Location a,nd legal escription of lot to be built on:
State work to be done and purpose of building (by floors) ,j , 7 . , , f: , ‘,t , , 0, .,.. \,,,
and for no other purpose.
New B Remodeling Addition. Repairs No. of Stories
To be constructed of. Kind of foundation
Roof Covering
Estimated Total cost of improvements $ ,, ,..- 4 ,.._ k c ' .
Amount of it $
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 pennit does hereby certify that he understand!: and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, e en ral Laws of Florida, Permanent Sul pleinent,
and has complied with the provisions thereof, and will require similar compliance fr all coo �attors r c ontractors employed by him
in the work to be performed nnder this permit; and will post or cause to be posted , ins atlpry on b ite oo the work such public;,notice
or notices as are required by the Act. The undersigned agrees to employ only sue J % ) ) to be performed uneler this
permit, as are licensed by Miami Shores Village. / , %� ,,,-„,, i /, 7
.3ednarks
STATE OF FLORIDA, p
COUNTY OF DADE. Ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPART M NT
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 ead the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
< �' r "` -- / ( Read, Sworn to and Subscribed before me.
Permit No _, ‹_ 3 S Date --
Disapproved _,^ // ' Date -c-//, T ) Notary Public, State of Florida
(Signed)
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Building Inspector/ ` My ommission Expires
PINNING BOARD _.__ DATE
Chairman J
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
Ow 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/or workmanship.