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657 NE 92 StSTATE OF FLORIDA, u. COUNTY OF DADE. Council Approved MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT BUILDING INSPECTION DEPARTMENT Application As hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regula- tions 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. 7 Date_ j,/,' Owner's Name and Address'"' ` ` A " ' / ; _ ei ',1.1 ' _ � J Registered Architect and /or Engin'er 6- le IS te .D f l , 7" Name and address of licensed contractor ! 1 " ) , 4 ' 7 A/ t X 4 1-S TL= d l=. ;. , e• , ('' t Location and legal description of lot to be built on: Lot__1_ Block -y Subdivision Street and Number where work is to be done__ ,K • State w to be one p urpose of building (by floors) -) - - P" - t _and for no other purpose. New Building Remodeling Addition__ Repairs No of Stories__ .4 t'r To b' constructed of �t_� _____ Kiad o fonpdation �_ �_ ` o f Love ing____ r - / • •ti, C Estimated Total cost of improvements $ -- a C' C Amount of Permit $_ f Zone cubage required____ Plan Cubage Distance to next nearest building Size of Building Lot 1 '' . Maximum live load to be borne by each floor I hereby s t all the plans and recifins for said building. All notices reference to the building and its construction may be sent to /41l dAJ7'"i�4' t 7 ll © ,. The undersigned applicant for this building permit does hereby certify that be understands and accepts his obligations as an employer of labor 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 performed under this permit; and will post or cause to be posted for ins ection on the site o wgr such pu 'c notice or notices as are required by the Act. The undersigned agrees to employ only such su ractors, .wor be mimed �7r h � permit, as are licensed by Miami Shores Village. `' K � -al � , Remarks (Signed) Before me, the 'undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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. � , r'-- Permit No._ Date � / F � a _� Read, Sworn to and Subscribed before me. Disapproved — __ Date Notary Public, State of Florida (Signed) � ft. L Btiildin nspectoc My Commission Expires _ ________��_ PLANNING BOARD DATE Chairman Member Member Member Member — _ Member Date Disapproved 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. I/ `2 No.___ Street_______________ to me well known, ____Date