912 NE 95 St (8)Owner's Name and Address.______.__
Registered Architect and /or Engineer._
Name and address of licensed contractor.
Location and legal description of lot to be built on:
Lot.
Street and Number where work is to be done
State wor to be done and purpose of building
Permit No
Disapproved -
(Signed)
Chairman
Member
Member
Council Approved
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
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 conrorm.ty with the Building Ordinance of Mai ii
Shores Village, Florida, and all provisions of the Laws cif the State of Florida. all ordinances of Mi inn Shores Village and all rules and
regulations of the Building Division of 'Miami Shor, s X illage sha'l ie complied with, whether herein specified or not. A copy of approved
plans and specifications must be kepi at building during progress of the work.
Block.__ ___.. Subdivision
Remodeling_
Date_
Date
ilding Inspector
BUILDING INSPECTION DEPARTMEN
(b )
PLANNING BOARD
o
No Street_
Date
Addition..... _
New Building
To be constructed of Kind o foundation .. Roof Covering__
Estimated T ,tal cost of improvements $__. r -- a
( 1 Amount c•. Permit $ . _.. _ , z
Zone cubage required
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
be sent to
Member
Member
Member
.Date Disapproved
__._ .Repairs.... ...
_Plan Cubage
and for no other purpose.
No. of Stories
The undo signed applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of L bor under •he Florida Workmen's Compensation Act. being Section 5966, Compiled Len.. -al Laws of Florida. P -r., amen Supple Went,
and h ,s complied with the prov'sions thereof, and will require similar come iance from all contractors or sub - contractors cmplo •ed by hint
in the wo k to be p rf- -med under this permit; and .Yill post or cause to be posted for inspection on the site of the work such public note. e
or '.otices as are requir d by the Act. The u..d.r d agrees to employ only such subcontr.. tors, o>i work to be perform d t der this
permit as are licensed by Miami Shores N illage.
Remarks__ (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths :.nd take acknowledgments, personally :‘ p-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the ___ _ ___ ______________ .....
of th abov, described instruction ti, .t h, has carefully read the foregoing application, and that he did sign the same, and that all tarts
therein by him stated are rue.
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Commission Expires. _ ........ ............
DATE
19
Date
NOTE: A charge of $1.00 will be made for making corrections or ::hanges to this application after approval li is hecn obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is ma:.ie necessary by improper notice for inspc••tam or I,o ity
materials and/or workmanship.