720 NE 94 St (3)Owner's Name and Address__._'"lG
Name and address of licensed contractor
Location and legal Iescription of lot to be buil�n:
Lot / 4 Block
Street and Number where work is to be done
But ding Inspector
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
r
MIAMI SHORES V L AGE
BUILDING INSPECTION DE R W ENT
AP PLIC ATION FOR BUILDI G 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 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.
Registered Architect and /or Engineer
Date
PLAN G BOARD__
72/49A Date ___.
No. .7 ...._ Street { N e 4 E.
A / // G ti/ ss /24aft
Subdivision ,.
y- Commission Expires
State wgrk to be done and purpose of building (by floors) J /7 G441, ift) &1 .(
{ and for no other purpose.
New Building Remodeling " Addition Repairs
To be constructed of 14 a '""Kind of foundation Roof Covering
Estimated Total cost of improvements $ (� Amount of Permit $ t'
Zone cubage required Plan Cubage_augpF_____ Y A_N �'C Al.' AZ.A_ - S.t o hl.__. 4 oo Size of Building Lot 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, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-co.. actors p , ed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site . t• - w. : public notice
or notices as are required by the Act. The undersigned agrees to employ only such .ntracto ., on ` f. ed under this
permit, as are licensed by Miami Shores Village.
Remarks.. (Sig O rJ
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
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 a '4 Date____.. � ✓ _ ' - -6
Disapproved
(Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
DATE
Member
Member
Member
Disapproved
,19
/4 Go- // /11
No. of Stones
to me well known,
Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
,
- '
1 0
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