1095 NE 95 StOwner's Name and Address____)( °_ __ V s
State work
Zone cubage required_
I hereby submit all the pl s and s ificatio for s ' b
be sent to
permit, as are licensed by Miami Shores Village.
Remarks
Disapproved
(Signed)
Building Insp96tor
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION 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 the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations 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.
DL LaL V
Registered Architect and /or Engineer ____ L ; d e
Name and address of licensed contractor - -, - _ T to '°"" 13'f S `
Location and legal description of lot to be b t on: 12'f 2. (;
Lot_______30__ __ __ Block 1 Subdivision $.R_V—T
Street and Number where work is to be done / Q_. ° .� � [� E _ � ��4 L
New Building Remodeling Addition 1 ° Repairs
To be constructed of G__ 9.S Kind of foundation____ .4.--L
- 1�,0_t - , !Roof Covering
,a
Estimated Total cost of improvements $__,s
Plan Cubage -
( Signed) _
Date
BOARD DATE
7
_ ,� Street ____ E
to be do piirpiseof building b floors)__
and for no other purpose.
No. of Stories
(Z.I.ft I fo r
Distance to next nearest building _____Size of Building Lot
Maximum live load to be borne by each floor —
es with reference to the building and its construction may
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 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 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 subcon ractors, on work be performed un1)er this
STATE OF FLORIDA,
COUNTY OF DADE. j 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 described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him sated are true.
Permit No Date Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member _
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty