525 NE 93 St (5)(Signed) - _
New Building_
To be constructed of
Chairman _
Member
Member
Council Approved
MA
®UILDIN INSPECTION DEIPARTMEN
AP LOCATION F® 6NG
Application is hereby made for the approval of the (let, fled statement of the plans and specifications herewith submitted for the build-
ing or other structure her.•i: described This t plicatic :, is made in compliance and con•ornrty with the Building Ordinance of Min, ii
Shores Village, Florida, and all pro isions of the Laws c f the State. of (•lurid:. all o d nances of Mi .ou Shores Village and all rules and
regulations of the Building Div.: i ,i of : iiam: Sho, ` illage h '1 ,e 'o. ipl.ed with, whether herein specified or not. A copy of approved
plans and specifications must be kep at buitdiiig durin progress of the work.
Owner': Name and Address___ _.g 1°1 Y 1l ,1- .)
Registered Architect and /or Engineer._.
Name rnd address of licensed contractor
Location and legal description of lot to be built on:
Lot. __ Block.._
Street and Number where work is to be done
State work to be done and purpose of building (by floors)___
Estimated " ;tal cost of improvements $
^ubage required ___
Distance to next nearest building__ _ _
Maximum live load to be borne by each floor
ed tstruction t,
stated are tr ie.
Permit No. _ !- _ . Date
Disapproved . ............
SHO
Subdivision
- -- - - - - -- - -- and for no other purpose.
Remodeling._ .__. _ .- Addition._ . __ .. _ ._. __ _ Repairs. _ _ No. of Stories
Kind of foundation _..____ . ._ Roof Covering
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 unde signed appli .ant for thCs budding permit does hereby certify twat he understands and accepts his :obligations as an employer
of 1: bor under he Florida Workmen's Compensation Act bung S . :on 596G, Cor,pled Gen -al Laws of Florida P r anon. Supplt Went,
and h s compl ed w;th he prov•.ions thereof, and will require s+nular comn tarnce from all contractors or sub - contractor cmplo ed by hint
in the wo k to be p rf med under th•s pern it and ill post or cause to bo posted for inspection on the site of the work su:h public not. e
or .otices as are requir d by the Act. The u. d, r ign.•d agrees to employ only such : iibcontr, ctors, on work to be perform d . der this
permit as are licensed by M am: Shores \ il:: ge. ' /'
Remarks (S;g'ted) . df/' a1 "
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally Ap-
peared
and who, being by me first d Iv sworn, upon oath depooes and says that he is the
of th abov.
therein by hi
l: has careially read the foregoing application, and that he did sign the same, and that ,.Il facts
Date.
kb
ES V @LLA E
Date
Amount c.c. Permit $..
plan Cubage
_Size of Building Lot
PLANNING BOARD _ - DATE
Member - - - ---
Member
Member
Date Disai moved
Street.
,196
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nission Expires_
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or :changes to this application , ftrr approval It s bet it obta Wed from
the Planr ng Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is m; a' necessary by improper notice {c r impr t m or he ,ty
materials and /or workmanship.
‘),, et q3',?-4--
1 A/R.CoIV6 , I N STA LL 'U A /D 11Ni/VPOYV