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275 NE 94 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 . No C ' 7 Street. Registered Architect and /or Engineer Name and address of licensed contractor �+ __ — s. P_S.�Q _ ? Location �� and legal description of lot to be built on: Lotat2n _W i . -._ _aZ Block STATE OF FLORIDA, COUNTY OF DADE. j ss. Street and Number ere work is to be done e1 2 4 ' � � /it e-i, State work to be done and purpose of building (by floors) �f i — Disapproved _ < D i e (Signed) �— -- Building Inspec P NING BOARD Chairman Member Member Council Approved Date NOTE: A charge of $1.00 will be made for the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date. I hereby submit all the plans and specifications for said building. All notices with reference to be sent to The undersigned applicant for this building permit does hereby certify that he understands and of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General L and has complied with the provisions thereof, and will require similar compliance from all contrac in the work to be performed under this permit; and will post or cause to be posted for i . on or notices as are required by the Act. The undersigned agrees to employ only such su permit, as are licensed by Miami Shores Village. Remarks__._ - (Signed) Read, Sworn to and Subscribed before me. DATE 1 , 19 Z. __ � 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 $ l 4 7e ©O Amount of Permit $ Zone cubage required 1 Plan Cubage__ Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor 8 the building and its construction may accepts his obligations as an employer of Florida, Pennanent Supplement r sub - contract s employed by him e site of the rk such public notice work to performed under this 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 Date Notary Public, State of Florida My Commission Expires Member __.. Member Member Disapproved Date making corrections 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