1147 NE 97 St (9)Name
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
Company
Phone #
Inspection Date
Approved
Correction
Re-Insp'n Fee
Location and legal description of lot to be built on:
Lot j Block /il
Street and Number where work is to be done
State work to he [lone and nnrnncs. of
MIAMI SHORES V' ILLAGE
BUILDING DEPARTMENT \
305- 795 -2204
Building Inspection Request
Date 05
Type Insp'n D a
Permit No. OP 0q_ -7 `/
purnCi
Address (( ' 1 fU E C) s(�
) 0C
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
/4'0 g 1 if / / 9/
Subdivision..
74'/ V ,l<�4
and for no other purpose.
1ddition Repairs No. of Stories
Roof Covering
Amount of Permit $
plan Cubage
Size of Building Lot
uilding. All notices with reference to the building and its construction may
Hereby certify that he understands and accepts his obligations as an employer
ing Section 5966, Compiled General Laws of Florida, Permanent SuLplement,
e similar compliance from all contractors or sub - contractors employed by him
or cause to be posted for inspection on the site of the work such public notice
to employ only such subcontractors, on w k to be performed under this
ly authorized to administer oaths and take acknowledgments, personally ap-
d says that he is the.
l the foregoing application, and that he did sign the same, and that all facts
/ .. Read, Sworn to and Subscribed before me.
DATE
ate
( Signed
Date 1
No )1
//
ee
19 -CC
to me well known,
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
ections or changes to this application after approval has been obtained from
re- inspection is made necessary by improper notice for inspection or faulty
/e