1270 NE 95 St (8)State of Ytorn,o, o .—
herein specified or not. A copy orapprovea-
Owner's Name and Address �!t! 46ey #iav
Registered Architect and/or Engineer 111 n W/S / & k
// Name and address of licensed contractor ( /
Permit No
Disapproved
(Signed)
Council Approved
Building Inspector
Date
VILLAGE
■EPARTMENT
LDING PERMIT
ifications herewith submitted for the building or other structure herein
of Miami Shores Village, Florida, and all provisions of the Laws of the
//ding Division of Miami Shores Village shall be complied with. whether
during progress of the work.
/ S treet
Location and legal de cription of lot to be built o ] te,,, y �Q
Lot P ci(6. 7 Block e Subdivision ,/V J // fo ?/ � " 0 " /
Greet and Number where work is to be done /9. 70 o ,/ )r' 6- ^ - j S //f gc7 �/ 777/, 4 c9�'2 t.ore.
�B'tate work to be done and purpose of building (by floors), state exterior colors (submit samples) 49/ f Z5r r 7 / ®r-t'!
and for no other purpose.
New Building Remodeling Addition Repairs No of Stories
To be constructed of Kind of foundation Roof Covering
e jtstii -" nated Total cost of improvements S 7 S — GP Amount of Permit S ' 7
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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's
Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and
compliance from all contractors or sub - contractors employed by him in the work to be performed and
on the site of the work such public notice or notices as are required by the Act. The undersigned
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
complied with the provisions thereof. and will require similar
s permit; and will post or cause to be sled for inspection
emp]py only such subcontractors. ork to be performed
STATE OF FLORIDA
COUNTY OF DADE. }ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
to me well known.
Date /1/ //S 9 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
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.
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.