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State work to be done and purpose of building (by floors)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 - 1escribed. 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... August 3, 71
Owner's Name and Address Victor K. & Nitza M. Rubovsky N 355 Street 93 St.
None
Regietered Architect end /er Engineers::::
Name and address of licensed contractor None -By owner `
Location and legal description of lot to be built on:
Lot 21, Block 1L6 Subdivision Miami Shores, Sec. 1 PB 10,P 70
Street and Number where work is to be done 355 N.E. 93 St.
Construction of 5' chain link fence
—• -- 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 $ 250 Amount of Permit $
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 Owner
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, Pennanent 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 e work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontrp on work perform 6 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 acknowleci,Q;nens, personally ap-
peared _ Q_A v S /k (
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the 3c'1 D e /Z (/1 WaJE2
of the above described construction, that he has carefully read the foregoing application, and that he id sign the same, and that all facts
therein by him stated are true.
Permit No /3 < 3. Date. — ' Rea SwAm to and Subscribed before me.
Disapproved _ _ _c� r _ ._ Date.
(Signed) v s
Notary Public, State of Florida - —
Building Inspector v Commission Expires. -: Qt3At3K• , Ik , J••Fr£4E- tf -.�y fE?tl - - Ent rr
c 3NV c O i THRUU o H , FRI- W. CNL:1T d,w o'J'Sd
PL:. NING BOARD DATE
Chairman 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
the Planning Board.
A re- inspection fee of $1.00 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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