47 NE 93 St (11)A
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Applicaton is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted :ror 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, aL ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein spec:fied or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address ,
Registered Architect and/or Engineer ,
Name and address of licensed contractor
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 purpose of building (by floors)
MIAMI SHORES VILLAGE
Date
No Street
and for no other purlose.
New Building . Remodeling Addition Repairs No. of Stories /
To be constructed of Kind of fonndation Roof Covering
Estimated Total cost of improvements $ / 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
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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 General Laws of Florida, Permanent Srpplement,
and has complied with the provisions thereof, and will require similar compliance iron 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 arc required by the Act. The undersigned agrees to employ only such sr hcontractors, on work to he performed under this
permit, as arc licensed by Miami Shores Village.
Remarks (Signed)
STATE CF FLORIDA,
ss.
COUNTY OF DADE.
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
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of the above deserbed 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
Disapproved Date
( Signed)
Date Read, Sworn to and Subscribed before mc.
Notary Public, State of Florida
Building inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved .Date Disapproved Date
NOTE: A charge of $1.00 will he made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of $1.03 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials and/or vvor.anarship.