434 NE 95 StApplication is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
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 regula-
tions 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
Zone cubage required
Distance to next nearest building
Disapproved ________________ Date •
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
•
Plan Cubage
Da
Size of Building Lot
Building Inspector My Commission Expires
Notary Public. State of Florida
, 19�
Street
Registered Architect and /or Engineer r'� !s� _
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot__ L _ _____ —_ Block �' Subdivision
Street and Number where work is to be done _J' £ • ,�
State work to be done and purpose of building (by floors) I>
and for no other purpose.
New Building_ Remodeling _ Addition_ Repairs No. of St91ries_____________
To be constructed of__a41.7.________ Kind of foundation___ __ -___ Roof Covering_
p c9cf` e ° c' 9 IC CD
Estimated Total cost of improvements $ _Amount of Permit $
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 be 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, u.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that be is the
of the above described construction, that he has carefully react the foregoing application, and that he did sign the same, and that all facts
therein by him stated are truce �,� �� •
Permit No-11_7_‘
o._ _� g ___ Date Read, Sworn to an,' Subscribed before me.
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
i)ate
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
Rev. 10/02/03)
RE- OCCUPANCY
APPLICATION
Date LA
City Miami Shores State Fl
Signature
J
SA A
Sign:
Print:
My Commission Expires:
Miami Shores Village
Building Department
-acs
3t�5 b� ,53 tv
Contact Name 5 -kne , Lou3cNn oi I Phone #
Buyer Seller Realtor i-•'' Name �jc��e �,(� t\\ l& ns I L1
Property Address -V `'[ NFL c 5-VrCi
I hereby certify that I understand that the zoning of the property is for single - family residential use and
that it is unlawful for more than one family to reside therein. I also understand that any Certificate of Re-
Occupancy that may be issued by Miami Shores Village certifies only that the referenced property is
being used for single- family purposes and that such Certificate does not constitute any representation,
warranty or certification as to the condition of the dwelling or other structures on the property.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate.
PP Deino;96 A licant Name
The foregoing instrument was acknowledged before me this day of
by � dl , who is personally known to me or who has
produced as identification and who did take an oath.
NOTARY PUBLIC:
1.015 E UNCIEY
MY COMMISSION # DD 361851
EXPIRES: December 15, 2008
6ontlld thin Notary NW Underwriters
Building Officials Approval:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795 -2204
Fax: (305) 756 -8972
Permit No. OS g-'
Loc ID
Zip 33 OS
200;
Re -Occ. $60.00
Notary $5.00
CCF
Total