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515 NE 93 St (10)Owner's Name and Address .... , i/ ° APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statc,, ur me plans and specifications herewith submitted for the build • inc 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, 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. Registered Architect and /or Engineer.. C.,crxi.F�9'1 D Y MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT C a CA). .,,, .,,,,.,..,.... Name and address of licensed contractor £—i T'? / s.. ;.T L Lot ©. Ul_2 .. No..:1,1 Street_.... oration and le al description of lot to be built on: ... � Block 5 Subdivision ..... ... .. it . l.-7. - 1.`rl; . 7 s — .._....�...1 ..__ State work to be done and purpose of building (by floors) 1.:.. cY ..G.I._..._.t..1L' Street and Number whero work is to be done STATE OF FLORIDA, COUNTY OF DADE. ss. ermit o. Disapproved (Signed) Date..4? Building Inspector Date.. NOTE: A charge of $1.00 will be made for the Planning Board. rc. inspection fee of 51.00 will be charged materials and/or workmanship. Estimated Total cost of improvements $..../.5.0 Ncw Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Amount of Permit $. (4- . Zone cubage required Plan Cubage Distance .to next newest building Size of Building Lot ............ for no other purpose. 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 permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida \WorkmPermanent en's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Su ileent, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed ui 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 subcontractors, on work to be performed under this permit. as are licensed by Miami Shores Village. Rein uks..._ (Signed).. Chairman Member Member ... _ ....._......_..._.�...._....... Council Approved Date Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 read the foregoing application, and that he did sign the same, and that all facts therein by him st re u P N Read, Sworn to and Subscribed beforeine. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE to me well known, Member Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty ) 2 o/Y 2 If 18 �( .3 %Z 7-1;p l�