50 NE 93 St (8)STATE OF F.LGR °DA,
COUNTY OF DADE. ss.
Cliai_rmc n -
Member - - -- - - - -
Member
Council Approved
1 Inspector
MIAMI E_ H R ES V L LAL
EFJE €Did; '_N SECTION t: fb€aARTM N
AFFULATILIN F LIR—DING PERM YT
Application is hereby made for the approval of the det.. fled statemen' of the plans and specifications herewita submitted for the build -
ing or o hi•: .trueture her r described This l -plicatu is made in compliance and con wilily w.tn the Building Ordinance of Mia rf
Shores Village, .or da, and all pro isions of the Laws c f the State of bh,rid.: ell o d nances of Mt iu Shcres Village and all rules oral
regu ations of the Building Div..; i of . •slim. Sho, illage l 'I a ^oi ipl.ed with, whether herein specified or not. A copy of approved
plans and specificati ms must be !cc! • at building durin progress of tl.e work.
,19 g,
'LANK :NG BOARD__
Owner'• Name and Address._. _ __.. :_
Registered Architect and /or Engineer
Name nd 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)
Date
No Street
New Building _= _ Remodeling.. ___ _ ._ _.__._ Addition__ . __ _ ... _- . Repairs. _ _ _ , /� No. of Stories
To be constructed of _._ . "(ind of foundation • ' '
Roof Covering _
c
,�
Estimated " .trl cost of improvements $__ -/ '.; _ Amount c ` Permit $._ _ ;7___ ___ _ _ .
one ^ubage required __ Plan Cubage___. r...2
Distance to nest nearest building . _ . __Size of Building Lot .A
Maximum live lo_d to be borne by each floor _ .
hereby submit all the plans and speci.i,•ations for said building. All notices with reference to the building and its construction mey
be sent to
The uncle signed appli ant for th 's building permit does hereby certify nit he understands and accepts his ..bligations as an employer
of I. bor under he Florida Workmen s Compensation Act bang S. ftion yf;63 Co: p led Gen al Laws of Florida P r. anon S•:pi ill pent,
and h s compl ed w :th he prov'.cons thereof, and will require s•rmiiar cos:: rari_e heir all contractors or sub contractors cmplo .ed by him
in the wo k to be p rt med under th s peen it and - ill post or cauv.c= to 'ie Hosted far inspection on the site of the work >:u -h publ :• notl e
or otices as are requir d by the Act. The u d.r ign d agrees to employ only such abcrjn r. ctors on work to be perform d . der th.s
permit as are license' by M am. Shores 5 it l: ge. , ,
3ema.ks (Sig icd) , % �/ = /! ,
and for no other purpose.
Before me, the undersigned authority, a notary public, duly authorised to ad•1'.nister oaths •.nd take acknowledgments, pc: :,anrll' ‘p-
peered
to me v,el! known,
and who, being by me first d lv sworn, upon oath deposes and says that he is the at th /sboc de c. 'bed istruction t, , 1, has ally read the foregoing application, and that he did sign the same, and tI at .11 f acts
therein by him stated are tr ie. //
I/ Lf� 9 ,;/' 7
Permit No.__ ____ __ ' � ' _ cave / '__ .__ ', Read, Sworn to and Subscribed before me.
Disapproved - - / Date__
(Signed)
Notary Public State of Florida
My Commis °ion Expires
Membe
Member
Member
Date Disapr.ro.. en - Date
NOTE: A charge of $1.00 will be made for making corrections e- changes to this application •ft.•r r.iproval I. s 1-.' i bta lied from
the Planr 'ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is m i s ncces.ary by improper notice fc r insp- • t•.a • or f c• ty
a :ater:als and /or workmanship.
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