253 NE 94 St (5)BUILDING INSPECTION DEPARTMENT
APPLLUCATDON FOR UEILLDllNNG PERiviMUT
Application is hereby utnde for the approval of the detailed statement or we plans and specifications herewith submitted for the build
r 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 oIl 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 -t7 r)
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot .... . 20 t 2) Block
Street and lumber where work is to be done
State wt to be done.and purpose of building (by floors)
2
MOAMII SHORES VOLLA E
NOTE: A charge of $1.00 will be made for
the Marmite; Board.
A re- inspection fee of 31.00 will be charged
materials anU /or workmanship.
i' cH
R egistered Architect and /or Engineer :___. . * . ... ...... .. ...•• „_._,e -_, -,_
Subdivision
Date..._ 62�... � O __.__.__ _.
, 19Y..
No. Z 1...3._.... Street F • (-- ,fl
t: iJ C e_ / J A` IG ..._ rz
_.._. and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation nQ oo1 Covering
Estimated Total cost of improvements $ 000 Amount of Permit 8.
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 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 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 provisions thereof, and will require similar compliance from all contractors or sub -con actors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of t r c wo .• ch public notice
or notices as arc required by the Act. The undersigned agrees to employ o• uc ar ,,. antra ors; o ark t• be ed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks...- (Signed).
Notary Public, State of Florida
PLANNING BOARD DATE
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 stet d are true.
Permit No.._A Date (4 4 4 Read, Sworn to and Subscribed before me.
Disapproved _.. ` e. Date
(Signed) • 1
Building Inspector My Commission Expires
Member
Member
Member --- -• - -•-
Disapproved Date
Chair ;man
\1crr,bcr
Member ..
Council Approved Date
making corrections or changes to this application niter approval has been obtained from
when such re- inspection is made necessary by Improper notice for inspection oar faulty