930 NE 95 St (9)MIAMI SHORES VILLAGE Sjr7�o�G
3 �e5 V 007e
4 APPLICATION FOR BUILDING PERMIT . ? ? � L /
Application is hereby wade for the appro\a1 of the detailed statement or inc plans and specifications herewith submitted for the bu •
inc 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 progreu of the work.
Street and Number where work is to be done
Permit No.._
Disapproved
(Signed)
... Date
Date
BUILDING INSPECTION DEPARTMENT
�
' Date. .�� ,E ,19..
Owner's Name and Address . . .. f C SY !14 ...
_ No.... Street S
Registered Architect and /or Engineer. •• ... ,,.,. ttt n
Name and address of licensed contractor e06E47 t/ • ..QsS/ ,, � O El arc / w• 5 i /0/4 m4 J CIV
Location and jcgal description of lot to be built on: 6 b
Lot Block Subdivision _ ._ .. »_�.
36 Z 4c : _9'15 S7 .._ »_.
Crnei QE_..._ ‘X /67 /.t/ 400 S 44 O
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires _
State ork to be done and purpose of building (by floors) _ - —. _... »» _...._.- _.._.._. -__
/ D /3 ‘q. /.c./" and for no other purpose.
New Building Remodeling . Addition Repairs No. of Stories _
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S /`s Amount of Permit S.
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
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 Genera s of Florida, Pennan ••t Sup plentent,
and has complied with the provisions thereof, and will require similar compliance from all co ac •rs or sub- contractor ployed by him
in the work to be performed under this permit; and will post or cause to be posted for insp . tie, on the site o the w uch public notice
or noticcs as arc required by the Act. The undersigned agrees to employ only such su on , formed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
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
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 cafefully the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
PLANNING BOARD DATE
Chairman Member
Member Member
Member .. .. Member
Council Approved 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 Pl.innir.g hoard.
A re-inspection fce of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
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DONALD W & ASSOr;IATES,
Reg. Surveyor,!7?", State of Ficr:dn
OT VALID UL EALED
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cONALD W. MANI AROCATES, INC.
531 N. E. 91ST ST.
MiAMI SHORES, FLA. 33138
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