988 NE 93 St (7)®RES W LL.AS E
UILD]N [INSPECTECN4 DAME
APPL! A hh LJILDING PERMIT
Application is hereby made for the approval of the (let., fled statement of the plans and specifications herewith submitted for the build-
ing or oiler structure her•a. described This i•l lica!ic is made in compliance and con-orm ty with the Building Ordinance of Mia ii
Shores Village, i-,or.da, and all pro• isions of the Laws f the State of Hurid, all o d nances of Mi. in Shores Village and all rules and
regulations of the Building Divi. i i of uanr Sho, iilage 1 '1 a o, ipled with, whether herein specified or not. A copy of approved
plans and specifications must be kei at build.ug durin, progress of tle work.
Date , 19 `
Street. NO -_
Owner' :: Name and Address.
Registered Architect and /or Engineer _ _
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot_ __ Block._ __ __ Subdivision_
1 ,
Street and Number where work is to be done ___:.
State work to be done and purpose of building (by floors) P h ad fD _ __. _ .._._ agi
—
1
New Building_ ...... _ %. Remodeling.. Addition._ . __ . Repairs. _ _ No. of Stories
To be constructed of _._ . _ . Kind of foundation _______ _ .._ Roof Cov
c
Estimated " ,tal cost of improvements $ v� 6 — Amount of Permit $.- .r '
Zone ^ubage required __. _Plan Cubage..
Distance to next nearest building. _ _Size of Building Lot
Maximum live load to be borne by each floor
Disapproved _ __. Date_
(Signed)
Bui ding Inspector My Com:nission Expires. ..... _
Notary Public State of Florida
-
and for no other purpose.
hereby submit all the plans and specirit•ations for said building. All notices with reference to the building and its construction may
be sent to .___._ __ _ __ _ _
The unde signed appli,•ant for th;s budding permit does hereby certify i'tat he understands and accepts his obligations as an employer
of 1 bor under he Florida Workmen's Conipens:ition Act. be'ng S. :.t:on 59613. Coi . pled Gen -al Laws of Florida. P r.canen Sipple ,tent,
and h s compl ed w ;th he prov',ions thereof, and will require similar conin lance from all contractors or subcontractor cmploed by him
in the we k to be p rf med under ths pernit and ill post or caul,. to be posted for inspection on the site of the work su h public not e
or otiees as are requir d by the Act. The u. d, r 'gill.' agrees to employ only such . ubcontn ctors, on work to be perform d . der this
permit as are licensed by M am: Shores \
Remarks_
(S�g l = 7 1
.../ n i
STATE OF FLORIDA, ss. ��� ��
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,.nd take acknowledgments, personally 'p-
pea :ed
to me well known,
and who, being by me first d ly sworn, upon oath depo ?es and says that he is the -_
of th abov. de c ibed istruction t, h has carefully read the foregoing application, and that he did sign the same, and tlat ..:I taus
therein by him stated are.tr ie.
Permit No,_._.__ i__ : . Date__ Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member _... ---
Member _ --- _ Member
Member _ Member .
Council Approved Date Disaprro‘ cd Date
NOTE: A charge of $1.00 will be made for making corrections or ^hanges to this application , ai proval 1 s 1 n ebta ued from
the Planr ng Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is m: :e necessary, by improper notice k r insp! t .m or fa• ty
materials and /or workmanship.