260 NE 95 St (2)M0AM E3=5 c ES VULLA E
BUILDING INSPECTION DEF lRTMENT
AP i LOC G OIR 8 OLDBNO 'ERMOT
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.
Owner's 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
Street and Number where work is to be done 0
State work torte done and purpose f building (by floors) Q
/
f / Date 7-- �,S ^ — 6
No c=2 rG Q Street
Building "pector
.- .
Notary Public, State of Florida
and for no other purpose.
New Building Remodeling . ........ __._ Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ ASS - ® 0 • Amount of Permit $ -00
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 su it all the plans an eecifica ions for said building. All notices with reference to the building and its nstruction may
be sent to- t 1 1 l < • c / 6 f ,,,
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 insp tion on the site of j ye work such )ublic. -otice
or notices as are required by the Act. The undersigned agrees to employ only such subcoj ractors ' on work be for p ".r, this
permit, as are licensed by Miami Shores Village. ..--"
Remarks (Signed) I__. /'
STATE OF FLORIDA,
COUNTY OF DADE. 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 stated are true.
Permit No c� � 9 Da , $ 3.° C< --- C' Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
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.