285 NE 95 St (9)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.
Owner's Name and Address .
Registered Architect and /or ''gineer
^
Name and address of licensed contrlctor. w "' c
in the work to be performed under this permit; and will post or cause to be posted fo
or notices as arc required by the Act. The undersigned agrees to employ only such
permit, as are licensed by Miami Shores Village.
Remarks..__ (Signed)
Dat
Disapproved Date
(Signed)
MIAMI SHORES VILLAGE
Building `hfspcctor
BUILDING INSPECTION DEPARTMENT.
ciyizr_o
Chairman
Member
Member ...... �... - ... - - — - ......
Council Approved Date
Dat ®..._..._....._... /1 _.. ,19..
— No. $ _ . street.YE 9S -
PLANNING ; DATE
Location and legal description of lot to be built on:
Lot Block SubdiviI 'on
A ,. ..
Street and Number where work is to be done 0 283^ r "C } _ � g � s � � � _3
State work to be done and purpose of building (by floors) . t"'w"
�� zd #boo %TL a 72
_._ 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 $ Amount of Permit $.
Zone cubage required _______._._.Plan Cubage
Distance to next nearest building Size of Building Lot
Maxirnum live load to be borne by each floor
I hereby submit all the 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 perinit 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
ection on the site of th•. • . k such ublic notice
actors, on work t .- rfoa' a under this
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 a true.
J e —
Permit No..
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
ommission Expires
Member
Member
Member �_._..._.
Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re fce of $1.00 will be charged when such re- inspection is mad® necessary by improper notice
materials and /or workmanship.
has been obtained frotn
for inspection or faulty