1026 NE 97 St (8)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.
Date ... �....... _ ...._....» __... »._._ .. ».... ,19
Owner's Name and Address 1 ... e' h'l -e'Y
Engineer t l-k�, - as •� <—�—� .,,,.. .,<,.. „, ,�....,,. -_,-
Registered Architect and /or ' e c -,.
Name and address of licensed contractor �.TQ41. P.,.._._ /LI.5 33 OO,.,.�1 1 bvz) 3 ) 3
�S bd fvis n v 9 )a Tr11:- .5.j b - -j yZ 7rt +
Location and legal description of lot to be built on:
Lot .! D
therein by him stated ar true.
Permit No.__.. L S sate
Disapproved ......
(Signed) 64
Street and Number where work is to be done.111.2,4
State work to be done and purpose of building (by floors) a...__._ art 1
and for no other purpose.
Repairs No. of Stories .. _
f Covering �' i i..n .........._..
New Building Remodeling Addition I/
To be constructed of... , .'.... 5 Kind of foundation - -- - h2.e lr.a.1 fi—
Estimated Total cost of improvements $..,1 J1 T' ` 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 pennit 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- contrac • tployec by him
in the work to be performed under this pennit; and will post or cause to be posted for insp ion on the site of the • k such blic notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcont ctors, on work to pf •tm under this
pennit, as are licensed by Miami Shores Village.
Remarks._._ (Signed) L,.'
Read, Sworn to and Sub 'bed before me.
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Before e, the undersi n d authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared 9__ .....
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 regoing application, and that he did sign the same, and that all facts
ubhc, State of Florida
Building pcctor 6 My Commission Expires...alob, yt tly..,,if,
oct. 16, 1
PLA : DIN iar
G BOARD DATE Bonded by Arican Fire P, Casualty Ca,
Chairman r/ Member — .-- .•. - -. --- .. - - - -•—
Mcrnbcr 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 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.