905 NE 95 StMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Reque t 3
Date , � � Ti e
Type Insp'n /° -L� C'0 e �� �.
t�
:Permit No. 6- 74
& LC&
Name
Address
Company
Phone #
,1
For Inspector:
Approved 1
Correction
Re- Insp'n Fee
6'009/
qi3/ 9303
G i ame Date
Name and address of licensed contractor
be sent to.
Disapproved
(Signed)
MDAMI SHORES VIILLAGE
BUILDING INSPECTION DEPARTMENT
APPlLOCATO Irk F
....... Date
UOLDO fNGi fPlERfailOTr°
Application is hereby wade for the approyal of the detailed statement ur 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.
Owner's Name and Address ... —
ksar _ A
Registered Architect and /or Engineer.. f3 ?., : :•• <„ne+nr+.. r.. r< °]� R•"
G tr , s . eu�.. -. ,�_a:� `.°' e,
Location and legal description of lot to be built on:
Lot Block Subdivision l � J
Street and Number where work is to be done 9 D J .cam 6 •
Date... _.: _ . v 10.6.
No _ . Street_ .
State work to be done and purpose of building (by floors) _ -- •-- • - - -•• - •••»••••••••---•••• - •--•• - ••--
and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $.../...011rra Amount of Permit TO'
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
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup i leurent,
and has complied se it 11 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 art the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such ubcontractors, oa work to be performed under thin
pcnnit, as are licensed by Miami Shores Village. L
Remarks (Signed)_ » 111... ___....__...r..
STATE OF FLORIDA,
COUNTY OF DADE. ss'
Bcfore 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 carne, and that all facto
therein by him stated are true.. P
Permit No.. 140 Date ! Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
to me well known,
PLANNING BOARD DATE
Chairman Member
Mcrr,bcr Member
Member .. _._._.__....._..._. ... - -- Member _..._
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to Ohio application after approval has born obtained from
the l'Linnir.. Hoard.
A re• inspection fce of $1.00 will be charged when ouch re- inspection ix made necessary by Improper notice for inspection as faulty
materials anti /or workmanship.