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79 NE 93 St (6)APPLICATION FOR BUILDING PERNICT Application is hereby made for the approval of the detailed statement or cne plans and specifications herewith submitted for the build • ine 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 anc; regulations of the Building Division of Miami Shores Village shall be complied with, whether .herein specified or not. A copy of approver plans and specifications must bc kept at building during progress of the work. Owner's Name and Address (�� / Registered Architect and /or Engineer Sr ' /fol. Name and address of licensed contractor L. a�. C' 41 Location and legal description of lot to be built on: Lot Block Subdivision Street and Nuatber where work is to be done peared Disapproved (Signed) MIAMI SHORES VILLAGE Date ing Inspector Chair;nan Member Member .. _....._......_..._.o ...._ Council Approved Date NOTE: A charge of $1.00 will be made for the Planning lto.ird. A re.in.peetiun fee of $1.00 will be charged materials anti /or workmanship. BUILDING INSPECTION DEPARTMENT Date..._.... . l ✓` // a State work to be done and purpose of building (by floors) _...„1f<` gr201.e.... ®__.._.... »_. __...- ........and for ro other purpose. New Building 1Remodcling 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. AU notices with reference to tbe 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 \\'prkmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied ssith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to bc performed under this permit; and will post or cause to be posted for inspection on the ice of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subco actors, oat k to be�perforrned under thlv pennit, as are licensed by Miami Shores Village. I(, 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 aft= to me well kart:moo, 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 stated are true.. Permit No.._ ( Date ill........._._ -- Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Member Member Member Disapproved Date making corrections er changes to this application lifter approval has been obtained from when such re- inspection is made necessary by improper notice for ;.nspectim% or faulty