290 NE 95 St (2)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.
Date..._..._.... — .._L. — _......_ ° ._.. ,, X 19.!
Owner's Name and Address -.. � .� ...._...._ � ...�. l No......
Registered Architect and /or Engineer.. . :. ia / S ...- ,.,.•. .,,..,,. .,.. ...•.•.,•,.,.•_.,..... r AVW
Name and address of licensed contr actor ./A4 � /1/ Alia.. Qe •' &` • •- /.��5>' - '
Location and legal description of lot to be built on: (� C _ / 9 3 /6
Lot.�t.-/` ryr. 4 Block �/0 S // bdivision.fh/ . ; . , 0 ` 1 1 ..1Q .Q......
Street and Number where work is to be done... �tO .4e ' ! •..•
State work to be done and purpose of building (by floors) ..._ � � ....-..,
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
236
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Disapproved
cam,
(Signed)
Building In, Pcctor
MIAMI SHORES VILLAGE
PLANNING BOARD
Chairman
\fcu,bcr
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re fee of $1.00 will be charged
materials and /or workmanship.
Amount of Permit S.
_Plan Cubage
Size of Building Lot
I hereby ubmit the plans and specifications for said building. All notices with reference to the building and its�nstruction may
be sent to. '. L/' / t 0 i.0 l/ C-- 0 Afr il4frr4 / r.... '3. it )
The undersigned applicant for this building pennit 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 rovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
he work such public notice
be performed under this
in the work to be performe d under this permit; and will post or cause to be posted for inspection on the site
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractor
pennit, as are licensed by Miami Shores Village.
Remarks (Signed)..
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 p1 foregoing application, and that he did sign the same, and that all facts
therein by him stated ar true,_ � � �
Permit No.. � / � Date �a Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
DATE
to me well known,
Member
Member
Member — . - -..._
Disapproved Date
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
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