1026 NE 97 St (7)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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 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
Registered Architect and /or Engineer
Name and address of licensed contractor ____ _ •
F.l�J +L
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and p of building (by floors)
,L / " e4
A) crI -- . lJE.�S9.2
New Building
To be constructed of
Estimated Total cost of improvements $___
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No
Disapprove
Date 19 19__4"
���±___ ✓___ No Street / - - - _�
Building nspector
e first duly s
. ed constructi .
the are true.
PLANNING BOARD
DATE
ead, Sworn to and Subscribed before me.
and for no other purpose.
i %1
ion . f pairs No. of Stories
e .1F �NC_a Roof overing
R odeling
Kind of foundation
15Q Amount of Permit $__
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 General Laws of Florida, Permanent 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 site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub .ntractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. j (� Remarks ( Signed) '� git,r2ia -- — - --
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, be' i g b orn, upon oa eposes and says that he is the
of the abov des. , that he as . ' efully re the foregoing application, and that he did sign the same, and that all facts
therein by
Notary Public, State of Florida
My Commission Expires
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
aterials and /or workmanship.
1■)E• 9r2E4zT
10242
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ALLET
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