55 NE 94 St (5)Owner's Name and Address
MOAMO SHoG ES V LLLQD
BUILDING INSPECTION DEPARTMENT
APPLO(CATO N FOR EJUOLDDNG PCs°DPIDT
0
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.
Date / , 11(
No. 1 — Street___ 'L _ G /
Registered Architect and /or Engineer J
Name and address of licensed contractor __!._ IC...,
Location and legal description of lot to be buil on:
Lot
' , % /i1 ( Y/
G_ li� L _ Block Subdivision / ` ° ' ,/e C` s
Street and Number where work is to be done J . f " !Y / I .c
State work to be done and purpose of building (by floors) X L /7 l r 4/4r ° .. e .z. 7i - s c f
and for no other purpose.
New Building _ ... Remodeling L.--- Addition Repairs No. of Stories
To be constructed of C. /! 5 Kind of foundation Roof Covering
Estimated Total cost of improvements $ • . 1 c -- Amount of Permit $
Zone cubage required .Plan Cubage
Size of Building Lot
Distance to next nearest building
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 and ands art'd accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Com ed General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance om all contractors on subcontractors employed by him
in the work to be performed under this permit; and will post or cause to be post for inspection on the ' e of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only s h suhe6nt ctor , o work to be performed d s
permit, as are licensed by Miami Shores Village. I /
Remarks (Signed4' L
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 _
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 ..?, .7 D ate 3-3t — C_ (" Read, Sworn to and Subscribed before me.
Date
Disapproved _ ..
( Signed)
Building Inspector 1 My Commission Expires .
Chairman ... _ ..
Nleruber .
Member .
Council Approved
Notary Public, State of Florida
PLA ING BOARD DATE
Member .__.
Member
Member
to me well known,
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 imp:;., for inspection or faulty
materials and /or workmanship.