54 NE 95 St (4)MIAMI SIDES VILLAGE
BUILDING N =``,C .':ON DEPARTMENT
APPLICATION °' a B UILDING 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 ie. 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.
Council Approved
Owner's Name and Address- --- - --- - -- -- -- - --
Registered Architect and /or Engineer.. _
Name and address of licensed contractor___. ../7
Location and legal description of lot to be built on:
Lo .
Block _ Subdivision__
Street and Number where work is to be done -�
State work to be done and purpose of building (by floors)._
New Building Remodeling._ ..._
To be constructed of Kind of foundation_
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
. 2-
1 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, Pennanent Supplement,
and has complied with the provisions thereof, and will ref uire similar compliance from all contractors or sub - contractors mployed by him
( in the work to be performed under this permit; and will post o: cause to be posted inspection on the site o the work uch public notice
`\ or notices as ase required by the Act. The undersigned agrees to employ only s s contractors, on w be p ornT1 under this
\ permit, as are licensed by Miami Shores Village. // ,,
Remarks _- _ (Signed)_ _ . - `
STATE OF FLORIDA,
441/, COUNTY OF DARE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths
peared
PLANNING BOARD
MR-44 Date__ ,
Nc. � Y Street- - _ f
Addition
_ Amount of Permit $
_Plan Cubage _. ..
Size of Building Lot._
and
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 No 7g! U Date. '' /lh — 4'. .. Read, Sworn to and Subscribed before me.
Disapproved ___ at
(Signed) L
) 4_, 7d_-.e___- Notary Public, State of Florida
_ - --
Building I actor My Commission Ex:pires_ ... _
DATE
Chairman _ -- Member
Member _ Member
Member Member
and for no other purpose.
Repairs.. No. of Stories
Roof Covering
take acknowledgments, personally ap-
to me well known,
Date Disapproved Date
NOTE: A charge of $1.00 will be made for making co - ree ;ions 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 sL h re. n .,pection is made necessary by improper not ce for inspection or faulty
materials and /or workmanship.