67 NE 94 St (6)M
SH *RES VILLAGE
U LLDING INSPECTION DEPARTMENT
APPLICATION FU BUILDING PERMIT
Application is hereby monde 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 ds 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 9;
Location and legal description of lot to be built on:
Lot Block
Street and Number where: work is to be done
State work to'be done and purReso. of buildin
/3",'"),
f Date -._... ,
d� <'L .a. No
Registered Architect and /or Engineer..
Name and address of licensed contractor. ea 4e L
�. ='� r' s^
New Building Remodeling Addition
Subdivision
7 N ,�: ..l J , -, 9 -P [ • NIA ; v ✓ � f _ A� i, l ?. e }� ;
6 (by (loor.) � --'iuf7rf''-' :.. e A� � .,;(, - ' eA :'T_ /_. K •
_..__ 7 _
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d for no other purpose.
Repairs 4.----- No. of Stories
To be constructed of Kind of foundation Roof Covering
i Amount of Permit
.Plan Cubage
Estimated Total cost of improvements
Zone cubage required
Distance to next nearest building Size of Building Lot _ ............._.._...._
Staxirnum 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 lVorkmen'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 such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sube» tray ors, on work be performed under this
permit, as are licensed by Miami Shores Village. /
Remarks (Signed) t.:..
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4.---
StreeL
Notary Public, State of Florida
My Commission Expires
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
to me well known,
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.._ 1 Date '� Read, Sworn to and Subscribed befcre m .
Disapproved
(Signed) %.,��� -.�� °"
Bui�ding�Inspcctor i
PLANNING 13OA&iD _..__ .....DATE
Chairman Member
Member Member
Member .. .. Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after eppros•al has been obtained from
the Planning Board.
A re inppec•tion fee of £1.00 will be charged when such Qe-inspection in made necessary by improper noise for inspection or faulty
materials and /or workmanship.