1064 NE 97 St (13)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 confonnity 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 1 ept at building during progress of the work.
Owner's Name and Address _r _ No. Street
Registered Architect and /or Engin •er
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot_ Bloc); Subdivision
Street and Number where work is io be done
State work to be done and purpose of building (by floors)
r _land for no other purpose.
Remodeling Addition Repairs No. of Stories
New Building
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
and who, being by me' first duly sworn, upon oath
of the above describe construqtion, that he has ca
therein by him stated a true. "
Permit No - Date
Disapproved h_.______. Rate__
(Signed) „te. d
Building Inspector ./
Chairman
Member
Member
Council Approved
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
.,, 19
To be constructed of _____________ Kind of foundation Roof Coy, ring
Estimated Total cost of improvemen's $ Amount of Permit $_
Zone cubage required _ Flan 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 subcontractors, on work to performed under this
permit, as are licensed by Miami Shores Village. e
Remarks .,
(Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
eposes and says that he is the
fully reafl'the foregoing application, and that he did sign the same, and that all facts
/r
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD T DATE
Member
Member
Member
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
materials and /or workmanship.
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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
Location and legal description of lot to be built on:
Disapproved _ Date
(Signed)
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date - , 19
No Street
i '
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)'__
and for no other purpose.
New Building Remodeling Addition ____. Repairs No. of Stories
To be constructed of Kind of foundation. Roof Covering
_�
Estimated Total cost of improvements $____ _ : ___________Amount of Permit $
Zone cubage required i� _ — _Plan Cubage
Disrance 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)__
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
to me well know
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 '
therein by him stated are true.
Permit Date_„ -, Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires . -
PLANNING BOARD DATE
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
materials and /or workmanship.