401 NE 95 St (7)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
NOTE: A charge of $1.00 will be
the Planning Board.
A re- inspection fee of $1
materials and /or workmanship.
MIAMI SHORES VILLAGE
A 4/
Registered Architect and /or Engineer
Name and address of licensed contractor_
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
BUILDING INSPECTION DEPARTMENT
Subdivision
State work to be done and purpose of building (by floors)_
Disapproved Date
(Signed)
Building Inspector
Chairman
Member
Member
Council Approved
Date , 19
No Street
PLANNING BOARD DATE
- - - - -- and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
/ 'i
Estimated Total cost of improvements $ Y _ Amount of Permit $
Zone cubage required _flan 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 permit 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
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
(Signed) _____ ,:_______
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 firsVduly sworn, upon oath deposes and says that he is the
of the above described cotstruction, 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.
i
Permit No. Date_ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Date Disapproved Date
made for making corrections or changes to this application after approval has been obtained from
.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty