501 NE 94 St (8)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application 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 n t. A copy of approved plans
and specifications must be kept at building during progress of the work.
Owner's Name and Address_e:e
Registered Architect and/or Engineer_
Name and address of licensed contractor
Location and lega description of lot to be buy, on:
<4;
Lot _______ Block_6'6__ Subdivision_
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Date__
Building Inspector My Commission Expires_
es-
No ______
__and for no other purpose.
New Building__ Remodeling_ Addition Repairs No. of Stories__
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $__21 _e.. of Permit $
CP 0
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
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-stich public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontrac is, on work to )e ed under th• --A--
,
permit, as are licensed by Miami Shores Village.
Remarks (Signed) ,..&,
_. _
—..'.\ ..:e .'- -
STATE OF FLORIDA, se.
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 read the foregoing application, and t he did sign the same, and that all facts
therein by him stated are true.
Permit No Read, Sworn to and Subscribed before me.
Disapproved ______________________ Date_
(Signed)
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council 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.