544 NE 93 St (5)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATI ®N FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for 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 aws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Sores 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.
1 Date. .-
Wall 544 N.E 93rd ' St
Ownee6 Name and Addecss... ,--..,,.,,,,,,...— .............. .........- .,,..,.....,,,-<,.._ , . „ -r, N ,,.,,. , ,,,,,,••_.__„ Strec .... .• „a..
Registered Architect and /or Engineer
ACTION SEPTIC TANK SERVICE 3251 N.W, 69th St
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision._ .
Street and Numbe where work is to be done
5 N.E. 93rd St
State work to be one and purpose of building (by floors)
40 RELAY
and for no other purpose.
New Building Remodeling Addition Repairs X No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit
Zone cubage required plan Cubage
Distance to next naarest building Size of Building Lot
Maximum live load to be Lune 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 Iabor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be pzrformed 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 are required by the Act. The undersigned agrees to employ only such su., . ctors, on work to performed under this
d e
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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,
therein by him stated are true.
Permit No (.n C ( ( y , Date
: ( \ ate )
PLANS i G BOARD
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
__ me well known,
and that all facts
Building Inspector 1 y Commission Expires
DATE
Chairman Member
Member Member
Member - Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.