62 NE 93 St (5)Owner's Name and Address
;Registered Architect and /or Engineer _.
Name .:r_d address of licensed contractor __ f : !' __ '
Chairman
Member
Member _
Council Approved
MIAMI S H O R E S VILLAGE
E313ILDIN INSPECTION DIrPARTMEN
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the deL iled statement of the plans and specifications 'herewith submitted for the ' zu`_Id-
:ng or &her structure herein described. This ,tpplicatico is mace in compliance and conformity with the Building Ordinance of Miai.1f
Shores Village, H lor:da, and all provisions of the Laws d the State of Flurids. all o finances of MLmn Shores Village and all nines and
regulations of the 13uirding Divi :ion of Miami Shore- \. illage 4.: be complied with, whether herein specified or not. A copy of ape roved
plans and specifications must be kepi at building durinc progress of the work.
No.__ , _ „' ^, »: / Street.. - �-
r.
Log 'on and legal description of lot to be built on:
:Lot — - - Block. `‘ Subdrvsnon %// Z
Street ar_d Number wsere work is to be done .iV_ __, < >_ .' . % _/=< 1- !_`i
:state work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. `
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persona :1y ap-
peereza -
- — to me well `.> _own,
and for no other p ; rpose.
New building- __ - Remodeling.- _ -_ _ - -. Addition__ __ _ __ ___ __ _ __ __ _ Repairs.. _ . - . - No. of Stories
To be constructed of _ Kind of foundation _ Rocf Covering__ _.. _____ _
:estimated ” :tan cost of improvements $.. ; ;_'_,' :'- �U. Amount cf. Permit $__
Zone eubage required _ -. -- -_ _- -Plan Cubage -- - - -
`
Distance to neat nearest building _z ° _ % ______ _ Z -___Size of Building Lot .
Maximum live load to be borne by each floor ___ -. - --.- .-- -•-_ -- -.- . --.- • __ —_ -__..
hereby s - -brit all the plans and specifications for said building. All notices with :reference to the building and its eonstruetia : may
ba sent tc.- --• - - - —
The untie signed applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of 11 bor .nder he Florida Workmen's Compensation Act. being Section 5966, Compiled, Gm. —al Laws of Florida, PM•r, nanene Supple Went.
and h s compl ed wIth he rov - .ions thereof, and will require similar comniance from all contractors or sub - contractors cinplo ed by Rini
in the wo k to be p rf . - med under this permit: and will post or cause to be posted for inspection on the site of the work such public noti: e
or •otites as are requ r d by the Act. The uederign: d agrees to employ only such subcontr..ctors, on work to be perform- d der this
permit as are licensed by M ami Shores ' illage.
Reracsks_ (Signed).
and who, being by me first duly sworn, upon oath deposes and says that he is the ._. _
of th abov. de.c ibed istruction- t.. t h. has carefully read the foregoing application, and that he did sign the same, and that eel :acts
therein by him stated are true.
Permit No._____ '___ - Date__ ___L Read, Sworn to and Subscribed before me.
Disapproved _ Date -- --- - -_ —_-
Notary ?ublic State cf Florida
(Signed) - -- _ -_ -- .
Building Inspector My Com:nission Expires
PLANNING BOARD- -- ---- -- - - -- -- - -- . - DATE
Member ._ .. .
Member . _-
Member
Date
./ j • ,
,,vj3d: )/
•
_ _ - 4___ Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to th •:s application after approval ills been chtain:d _'rom
the Planr:ng Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is me .fie necessary by improper notice for inspc! t ;ri cr ty
materials and /or workmanship.
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:N SPEC:'TlO" 1DF PA'ITMENT
A PE__! AT DN FOR ' s D NG PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fa: the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Crdinar_:e of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and .1111 rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether hercir specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date
Owner's Name and Address ° " No. __ __._ Street .,—
Registered Architect and /or Engineer . __
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Blocic Subdivision
Street and Number where work is to be done
State work to be done and purpose of building ( floors)
_ and for r0 Oi: 1CT purpose.
New Building Remodeling Addition Repairs .__...___ 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 nearest building _Size of Building Lot _
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 con,trsction may
be sent to_ _ .
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligaticns a; an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General 'Laws of Florida, Pennane it Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors eir plover' by him
in the work to be performed under this permit; am, will post or cause to be posted For inspection on toe site of the work sue] p ibiic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be perform: d unth r th
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
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above describ nstruction, that he has c 11_y read the foregoing application, and that ae did sign the same, and that aII :'acts
therein by him st 4 aare ,;
Permit No.___. __ i�!" °* __'. �.___ Date__ +�.__d Read, Sworn to and Subscribed before me.
Disapproved Date_
Notary Public, :state o.: Florida
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD 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 her n obtained from
the Planning Board.
A re- inspection fee of 01.00 will be charged when such re- inspection is made necessary by improper notice for insprt ton or faulty
materials and /or workmanship.
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