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1146 NE 97 StOwner's Name and Address / 1 / Registered Architect and /or Engineer peared Permit No.__ Disapproved (Signed) 1 lu STATE OF FLORIDA, COUNTY OF DADE. ss. and who, being by me first duly of the above described construe therein by him ta; mare tr e. NOTE: A charge of $1.00 will be made for the Planning Board. A re-inspection fee of $1.00 will be charged materials and /or workmanship. A• r 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. r sworn, upo n, that he Name and address of licensed contractor 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 purpose of building (by floors) Chairman Member Member Council Approved Date f Date , 19__, t f� - • Remarks_ PLANNING BOARD 1 DATE 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 .Plan Cubage Distance to next nearest building _ Size of Building Lot / c` Maximum live load to be borne by each floor_______ — i 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. �. (Signed)_ - -- -'= - Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- to me well known, oath d poses and says that he is the as car ully read the foregoing application, and that he did sign the same, and that all facts Read, Sworn to and Subscribed before me. Notary Public, State of Florida Commission Expires ember Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty 1 ; I 2 t C i 4 \ 1 f f ,v - ' (. \ (<i E ar ��\ ,.� Remarks orr Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regula- tions 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. 9 Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Permit No. Disapproved (Shined) Chairman Member — Member Council Approved______ MIAMI MHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Building Inspector / / Location and legal description of lot to be built on: Lot___— _:_____ Block___ Subdivision / 7 / Street and Number where work is to be done l� f ____ 6� —_ _____ — :__ —__ 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 _ C., 4 _ /Roof Covering 4__, P Estimated Total cost of improvements $_ —_ l ___ ( - Amount of Permit $ w _- Zone cubagz required— _Plan Cubage - - zc-- ___________ — ____ _Date (Signed) i P Date - -- -- -- - — 19 -- . Distance to next nearest building__ _ —___ _ __ — —__ __ ___ __ —Size of Building Lot __— __ L_� �_ 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. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appear"d Da ke__���___= Read, Sworn to and Subscribed before me. D Notary Public, State of Florida My Commission Expires_ PLANNING BOARD DATE Member _ Member Member Disapproved to me well known. and who, being by me first duly sworn, upon oath deposes and says that':te 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 Da 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.