1006 NE 97 St (14)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
f ( 3)4 / 7 0)--34
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statc,iu•nc err 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.
Owner's Name and Address Me $.. . . ,r14.0 • G RE I _N ELL '
F. FLAQUEP. •
Registered Arehitect- and /or Engineer 1 si4s
Name and address of licensed contractor A iP-. LITE oiv p u.STRi ES lg. -55 W '__84 STS Ui A LEA- H _ FLA -
Location and legal description of lot to be built on: \
Lot 1 1 Block .1 g 1 Subdivision.. . 5 Ito t t'�f C _..1 4`� -P S tt,r
Street and Number where work is to be done �¢ ®®�' 14° E 17 t 6 - R..Ee '
State work to be done and purpose of building (by floors)...__? OL 4 - 12-gE14) ' ® W2 •
Data..._ - ......_... P f«ii " ..._.__... »... ,19.
10
MTIVI.14.1 11.
New Building Remodeling Addition V Repairs'
To be constructed of 4LL' . SCl J & Kind of foundation... j £ TE � E i xiST,i�66) Roof Covering.44 - j(zEeN '
co
Estimated Total cost of improvements $ 2 .1 Amount Amount of Permit S. ®�
Zone cubage required .Plan Cubage
Distance .to next nearest building. Size of Building Lot _. ......... _ .. .... ................... _.._...._
Mfaxiunum 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 - 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 s of thew such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su tractors, on to be formed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
and for no other purpose.
No. of Stories _
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Bcfor e, the undersig d authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally ap-
peared Ot5E T fP0F
and who, being by me first duly sworn, upon oath deposes and says that he is the. C oN 4 R P. --) P
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, arid that all facts
therein by him ed are t �
/� '
Permit No..
Disapproved
(Signed)
Building Inspector
Date
Date
rY
Citair:nan
Member
Member
Council Approved Date
to me well known,
to and S • scri • before
Nota Public, State of Fl ' 8 �
NOTARY PUBLIC STATE e F FLORIDA At LARGE
My Commission Expires .19.cree,m.h14,36.toti.etitifct.t,t4 e I 17 1981 .
PLANNING BOARD DAT EBONDED THRU GENERAL INS , UNDERWRITERS
Member
Member ._
Member —
Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after apprnval has been obtained from
the Planning Board.
A re-inspection fee of 11.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or worktnanship.
13