450 NE 94 St (9)Application is hereby mode for the approval of the detailed statement or me 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, I lorid.t. and nII 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.
Owners Name and Address
Registered Architect and /or Engineer ,.n, n.•••,,, : o a.„ n n ,e„
Name and address of licensed contractor. 't fidi - 1‘,) .• - = 2 - , -- , e -• .. 0
Location and legal description of lot to be built on:
Lot Block Subdivision —.. -- --
t -,s a A": 1 ' - -- - _ � - ie i - E_ _ . - k._ � . ..._ ..�.
Street and Number where work is to be done _ _..... »__...._.. __...._..... _ .._
State work to be done and purpose of building (by floors) , Ai-ti " - .e?... 1—L- q U' W t- ./ ..--t':'''''' a : .: - .._._..__.
_... " n , in /' : ... Y� .., / ?,- :S _ .... / '' 1` ". r) ,- ; - ,,'n / t< /,, ei ,.: e, j - and for no other purpose.
New Building Remodeling Addition
To be constructed of Kind of foundation Roof Ctt,vering
or ,
Estimate Total cost of improvements $ ... . .•• i• • :•3 C ( % Amount of Permit
Zone cubage required plan 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..
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
......_____.__........ 19 ...
_. Street_. ` 4< y / Y.' T e.
Repairs No. of Stories
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 \Vorktuen'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 hint
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 arc required by the Act. The undersigned agrees to employ only such su o ntradors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remuks (Signed)_ �.._
.e Date
911
uilding Inspector
Disapproved
(Signed)
peared
FF r
Permit Date � .�.�•. � 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
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval
the Plannir.g Board.
A rc•impection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice
materials and/or workmanship.
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-
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 careful }y read the foregoing application, and that he dfd sign the same, and that all fads
therein by him stated are true. a
Date
has been obtained from
for inspection or faulty