67 NE 94 St (10)APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted or the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
l-ures \Tillage, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
-cgulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
flans and specifications must be kept at building during progress of the work.
Data ---------------------------------------- ,19
Owner's Name and Address _ No Street
Registered Architect and/or Engineer
Name and address of licensed contracto-
Location and and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to bc done
State work to be done and purnose of building (by floors)
New Building
To be constructed of Tand of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required _Plan Cubagc
Distance to next nearest building _Size of Building Lot
Maximum live load to be borne by each floor
hereby submit all the plans and specifications for said building. All notices with reference to the building and its construetion may
be sent to
The undersigned applicant for this building permit does hereby certify that e understands and accepts his obligations as an employer
of labor under the Florida Nilorkn:en'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-cortractors employed by him
in tne 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 subcontractors, on work to be per7ormed under this
permit, as are licensed by Miami Sores Village.
Remarks - ----- (Signed)
STATv
'iority, a notary public, duly authorizcd to administer oaths and ta:ce acknowledgments, personally
7• 154 ap-
° I: he has carefully read the foregoing application, and that he did sign the same, and that all facts
/
1 A
n .4
te , ' ,
Read, Sworn to and Subscribed before, me.
0 ti
1-,
't T: 76
%
a "O
o \
\ Irt o
Notary Public, State of Florida
fl
A-0
. -4.
\ \ ' (C).
.4.
l r , My Commission Expires
1
"r1
\ 1,,
\ (1)
,.
\ VI
, NG BOARD_ ' // - -.:,L_.. ________ DATE
Member V
_.
\ \ 73 Member
■ \
5: Member
\
LI Date Disapproved _Date
\ \ 11
III
T making corrections or changes to this a
PPleation after approval has been obtained fron
\ \ -A
'6 , when such re-inspection is made necessaryb improper notice for inspection or fai
MIAMI SHORES VILLAGE
EIIIILDING INSPECTION DEPARTMENT
Remodeling Addition Repairs No. of Stories
0 upon oath deposes and says that he is the
z
and for no other purpose.
to me well known,