67 NE 94 St (12)•
Owner's Name and Add -e
3.141.:erecI Architect a.*id /cr Enginer�
N11712 and address of Iiceneed contractor
1_or..ion and legal description of lot to be built on:
Lot__ -- q Bloc c —__ Subdivision
Street and Number where work is to be doue_ -_- -! _- ,.--- --= - -- =-_
State work to be done and purpose of building (by Boors)
STATE OF FLORIDA,
cs.
COUNTY OF DADE.
Permit No._ Data
:Disapproved __ ---- -_ —_ -- Date
(Signed)
Council Approved__
MIAMI S H O REO Vl LLAf3 E
BUILDING INSPECTION DEPARTMENT
Sniiding In_9pector My Commission E:tpires_
PLANNING BOARD DATE
Chaff rman Member
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 rule; and regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plank =
and specifications must be kept at building during progress of the work.
-- - - - - -- 19.
- - - - - -_ -_and for no other purpose.
New Building__–____.._______ —__ _ Addition_ R'pars No. of Stori ^s___, ________
To be cons:z-ictec, of_ _ "'
__.�__�_ ,.raa of cf our) <arrb__ Roof oveang
Ettic'ated Total cost of i. +_aprovemeuts $ -- ^ - - - -- Amount of Permit $
Zone csbage :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 specifieaticnr•: for said building. All notices with reference to the building and its construction may
he 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 perfor.;oed 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 are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
perrrit, as are licensed by Iv iami Shores Village.
Remarks (Signed)
Before me, the ri-en:.imsecl authority, a notary pubi.ic, duly authorized to administer oaths and take acknowled &meats, personally
appeared
to me well known,
and who, being by me fat 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.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Member Member
Member Member ..—
Date Disapproved Date
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval has been obtained from
the PIanning Board.
A re- inspection fee of S1.00 will be chargeri when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
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STATE OF FLORIDA)
SS
COUNTY D DE
7d9
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County of Dade and State of Florida, being duly sworn, doth depose
and say, that under the provisions of Section B -368, Sub-sectLon (d),
of the Building Code of Miami Shores Village he desires to build a
.3 /N45[E - s4• / YY 2'Jf ,i,' c" ' on Lot - At
Block o.E' ° 9 ?5')f✓ 't TI subdivision, that he
is the owner of said property, and will be the owner of saic
and that he will, at such times as are required by the Zoning and
Building Director: --
1. File plans and specifications and obtain approval of
Village Planning Board and of the Building Inspector.
2. Apply for and secure a permit.
3. Pay the requires' fees, for license and for permit.
4. execute the work in accordance with the provisions of
the Zoning, Building, Plumbing and Electrical Codes of
Miami Shores Village.
5. Apply for inspections.
6. File with the Building Inspector certificates trat pro-
vision has been made to carry the necessary Workman's
Compensation, Public Liability and Property Damage
Insurance.
7. File with the Building Inspector as the job progresses
certificates showing the payment requirod by the
Federal Social Security Act to tho State of Florida
or the Unitod States of America.
8. Assume the responsibility of not employing other tnan
properly licensed contractors by Miami Shores Village
for any part or portion of the work.
C. Not set himself up as a "Contractor ".
10. Execute Builder's Bond.
And further this Deponent says not.,
1 .
SUBSCRIBED AND SORN TO BEFORE ME this da of /�
Y
A.D., la
2.
1. Signature of Applicant
2. Signature of Officer administering oath.
of the Village of Miami Shores,
, that he will do the work personally,