500 NE 93 St (6)» <2
; '- I -`
7 -t
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN':
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det,iled statemen of the plans and specifications herewith submitted for the build-
ing or o lb ....iructure her i described. This ri licatic is made in compliance and con aim ty w.th the Building Ordinance of Mix ii
Shores Villaoe, or da, and all pro • isions of the Laws cf the State cf 1.krid. all o d nances uf Mi m Shores Villag e. and all rules and
regu'ir ion.. of the Building Div... of ' .iam. Shoi ' iilage 1- '1 ,e o Tied with, whether herein specified or not. A copy of approved
plans and specificati .re4 must be kel. at building durin progress of tl_e werk.
Date Ft v 1(31 19r 9
Owner' Name and Address "
F4Atze c. N
0 Street.ff tA N
II 5/14
Registered Architect and/or Engineer. L 4 5 I
Name nd address of licen contractor. /4 5'f).9 ..1. (4' C •
•
Location and legal description of lot to be built on:
Lot_
Block 57
subdivisi. /6c,frac
Street and Number where work is to be done: 5
State work to be done and purpose of building (by floors) e.s .
New Building_ Le- Remodeling Addition Repairs_ _ _ . No. of Stories
To be constructed ofCV /toll S 7 4 Kind of foundation Ro f %ring_ rt 1. 4.-
a
Estimated 7 - cost of improvements $__ __12, td ei Amount of Permit $ I
Zone -ubage required 1 7, f 0 a L Plan Cubage I V 2. 6
/
Distance to next nearest building__ _ _ Size of Building Lot
Maximum live load to be borne by each floor_
hereby submit all the plans and specifications for said building. All notices with reference to the budding and its construction may
be sent to ft L. f//2 /4f/? „44/4 f /co 44 a 3 r Mt/Ali - ---
The unde signed appli ant for th bulding permit does hereby certify nat he understands and accepts his ebligations as an employer
of 1 bor under he Florida Workmen's Compensation Act being 5966 Col p led Gen at Laws of Florida P r anen S)1pk nent.
and h s compl ed w'th he proV thereof, and will require s radar COMP lance from all contractors or sub .contractors emplo .ed by hini
in the wol k to be p rf -med under th's pern it. and ill post or cause to be posted for inspection on the site of the work su :h public noti• e
or otices as are requir d by the Act. The u. d r ign..d agrees to employ only such abcontr, etors, on work to be perform d . der this
permit as are licensed by M atm Shores S il!: ge.
( Signed ) 7 4.--et
Remarks__
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to adni_nister oaths r_nd take acknowledgments, personally p-
peared _
and who, being by me first dt ly sworn, upon oath depores and says that he is the
of th abov. de ,c.ib d • . istruetion h has c eiully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated
Perrnit No /
Date fr
Disapproved
(Signed)
Buildii g Inspector
Chairman _
Member
Member
Council Approved
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nission Expires_
/3 - DATE
Member
Member
Member
.Date Disapproved
and for no other purpose.
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application 'ft. r approval 11 is been obtained from
the Plannng Board
A re-inspection fee of $1.00 will be charged when such re-inspection is ma le necessary by improper notice fcr inspe: von or fa. ■ty
materials and/or workmanship.
I H iERTIFY` tfa { h, attached - a e:reich gpretenfs•
;urYey,mada, rider my direclio� adc ia' frt. and cfrect .
fo the bes(of my 4�rowiedgt� 4 belle
There ere,rtib ercfo i� ,•mss xce ! s v .
NY
LIE 5_, 6_4 >, 1 ri „2:10
z-;.
!mace
:
/�� � � �•\
\
1
Q.
1