702 NE 95 St (4)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n
Permit No.
Name
Address ! Oc r /
Company �i s A ,
Phone # (93 i_
For Inspector:
Approv
Correction
Re- Insp'n Fee
0 Name & Date
1 � i_
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date Time
Type Insp'n P' -•
Permit No. ,
Name
_ Address 7 v c
Company S V l A U9 ( .
Phone # (C2 9 9f Q G
For Inspector: � --) Name & Date
U
Approve
Correction
--°' N.<
`� 1
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
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot
APPLICATION FOR BUILDING PERMIT
Block 4. 7 Subdivision_ /(t t
New Building y� Remodeling
To be constructed of_ '2 Kind of foundation__
Estimated Total cost of improvements $
Zone cubage required
Permit No
Disapproved
(Signed)
cpacri
MIAMI SHORES VILLAGE
Date_
Building Inspector
BUILDING INSPECTION DEPARTMENT
Date
Street and Number where work is to be done �,___ __
State work to be done and purpose of building (by floors) 4! -e C_''i etir
A
I -
__Plan Cubage (7-'i r�
., 19
Street__
ddition R epairs No. oftorie S
_�:/ Roof Covering 1
Amount of Permit $
3 a s
° - r _\t
and for no other purpose.
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 - contract s employed by him
in the work to be performed under this permit; and will post or cause to be posted for ins section on the site of the
or such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub • tractors, on w k p. be /pprf.jmed under this
permit, as are licensed by Miami Shores Village.
Remarks___ ( Signed) __
r:
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 stated are true.
Date T 7 __ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved__ Date Disapproved Date
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.
Alt
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