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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 vlo Nf 4 76'i2 1 5 a