1044 NE 97 St (2)STATE OF FLORIDA,
COUNTY OF DADE. ss.
PP
M IAMI SHORES VILLAGE
1 BUILDING INSPECTION DEPARTMENT
Application is hereby utnde for thc� approval of the detailed statement of ute 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 Miafni
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores nd 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.
(CATION FOR BUILDING PERMIT
• Date _ •�G_�_�•r `� r .
Owner's : 'AMC an Address .. , i&(f. .� ®. f .,�
No, .4 f
Street ..
Registered Araitect and /or Engineer ... Yr. / P �
Name and address, f licensed contractor. L • ` C / /J4,.T.... .. . ....lc�
Location and legal desct.,tion of lot to be build orl: � �
Lot /�- Block....,.... ` S � ubdivi is sioon.d /. , �1/.1 . / .. .a..._.. .L ,..._......_..
Street and Number where work to be done.../ 1 ,�4 ° �.. .. ° .._... °•�s�Z _ —..,
State work to done and purpose .f buildin floors)
cl,
Bui ding Inspector
Disapproved ° Date.._.. ......
_..,
(Signed) . `
and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories
To be constructed of':l.�°?&I7V Kind of foundatio _ _ Roo Covering ,
Estimated Total cost of improvements $ /1; e e Amount of Permit $..
Zone cubage required It 97 ../9 plan Cubage
Distance to next nearest building..., t 19 Size of Building Lot 7 'X' "®r o/l
Mfaxiunum live load to be borne by each floor
I hereby submit all the plans Aid specification for said building. All notices with reference to the building an its construction may
be sent to 7 • e° AT717 S....... /de V Al. i41-ter,o
Notary Public, State of Florida
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
o f Libor under the Honda Workmen's Compensation Act, being Section 5966. Compiled General Laws of Florida, Permanent Supplement,
and has complied ss ith 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 subcontra- ctors, on work to be py med and this
permit, as are licensed by Miami Shores Village. -
Remarks (Signe Itetea,
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, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefull read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit N ft/Ai G Date .. -..4) ° j
° Read, Sworn to and Subscribed before me.
My Commission Expires
PLANNING BOARD DATE
Ciiair:nan . Member
Member Member
Member _..,. .._..._._ Member .. -._
Council Approved Dat 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 1'lannii.;; Board.
A rc- nispcction Ice of 31.00 will be charged when such re- inspection is made necessary by Improper notic*a for Inspection or faulty
materials and /or workmanship.