1084 NE 97 St (5)MIAMI SHORES VII_L GE
BUILDING INSPECTION DEPARTMLLNT
APPLICATION FOR BUILDING PERMIT
Api 7ication is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted'f� 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
Owner's Name and Address_____ __ __ ` % ' ��' �s Street_
10 No, l �. .
Registered Architect and /or Engineer
State work to be done and purpose of building (by floors ) _
New Building
To be constructed of
Estimated Total cost of improvements $ f f � 6 O F
Zone cubage required �" ���
` *d %;
Distance to next nearest building
Maximum live load to be borne by each floor 4 f
Permit No.__,__
• Disapproved
(Signed)
a
Building Inspector
NOTE: A charge of $1.00 will be made
the Planning Board.
A re- inspection fee of $1.00
materials and /or workmanship.
Name and address of licensed contractor '
Location and legal description of lot to be built on:
Lot � Block 1 ` 5 / Subdivision
Street and Number where work is to be done 1 _c
Chairman
Member
Member
Council Approved. Date
s ic
I hereby submit all the plans and specifications for said building. All notices with
be sent to" v
• s ? • �' Kind of foundation �S'' - � � '� " •
reference
Remodeling Addition Repairs No. of Stories
•
Date_ __ u__ Read, Sworn to and Subscribed before me.
Date
(;
Remarks__ ( Signed) '
Notary Public, State of Florida
My Commission Expires
19
and for no other purpose.
Roof Covering r
Amount of Permit $ F 71
"
flan Cubage
J 0
Size of Building Lot
to the building and its construction may
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.
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 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 foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
for making corrections or changes to this application after approval has been obtained from
will be charged when such re- inspection is made necessary by improper notice for inspection or faulty