930 NE 95 St (8)7:o , 77 777% (n7 "
CP:1.7.PEr?, TOG'
Application isY -reby made for the approval of the detailed statement of the plans and specifications herewith submittedefor 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 ordinanc i Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whethe erein sp d or not. •A copy of approved
plans and specifications must be kept at building during progress of the work.
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 work to be done and purpose of building (by floors )__ _____ _
New Building Remodeling Addit
To be constructed of C,___ Kind of foundation 1 .LL
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
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
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,
in the work to be performed under this permit; and will post or cause to be posted for ins sec on the site of th work el'
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors nploye
r if t / 7
or notices as are required by the Act. The undersigned agrees to employ only such subco
pefmit, as are licensed by Miami Shores Village.
Remarks (Signed
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments,
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 statid are true.
Permit No Date
,R ead, Sworn to and Subscribed before me.
APPLICATION FOR BUILDING PERMIT
Disapproved Datp
(Signed)
F
B uilding Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Block Subdivision
X 7_3®
lrt'_
— __ __Plan Cubage____ 3 +
_Size of Building Lot
ate
ctoos, on work toe pe
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after api
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper
materials and /or workmanship.
,- t
t-2 Q 1' &e i �1 r-
and for no other purpose.
pairs No. of Stories f
C.* Roof l91� g
of Permit $
personally ap-
$'o"
2_64
, ,
NER EE 0 • EIF3ELti -1 Atka
4-07 / Sua ,
7 ) g;
1/ Q 5.78
C eAr
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