1090 NE 96 St (2)Ak z,t_ r 14) 1 MIAMI SHORES VILLAGE
5 - 9,
Application is hereby mode for the approval of the detailed statement ur the plans and specifications herewith submitted for the build
inc 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...........
/� q � an dc1 f 1 nse ontrtctor
I/ J °L76M tion' arifd lcgil a cr ptio of lot to be lilt on:
Lot id I.e.
Street and Number where work is to be done
State rk to be done anclure of building
Disapproved ....V
(Signed)
APPLICATION FOR BUILDING PERMIT
Block
Building Inspector
BUILDING INSPECTION DEPARTMENT
Subdi
y floors)
Ncw Building
To be constructed of lt./C..—Kind of foundation
The undersigned applicant for this building permit does hereby certify that he understands
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Ge
anti has complied ssith the provisions thereof, and will require similar compliance froi
in the work to be performed under this pcnnit; and will post or cause to be posted f
or notices as are required by the Act. The undersigned agrees to employ only such
pcnnit, as are licensed by Miami Shores Village.
Rern.uks.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly
peared
1 Date
Date... —.. —..
building and its
Notary Public, State of Florida
My Commission Expires
_... „........ for no other purpose.
Remodeling Addition Repairs No. of Stories
Roof Covering
Amount of Permit $,. 1
Estimated Total cost of improvements $
Zone cubage required plan 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
be sent to..
construction may
and accepts his obligations as an employer
I Laws of Florida, Permanent Supple•iiient,
r sub - contractors employed by him
site •f the work such public notice
to be performed under this
authorized t
igned)
ntracto
minister oaths and take acknowledgments, personally ap-
-. 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.
Permit No.. .Zhg Date. Read, Sworn to and Subscribed before me.
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 fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
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Application is hereby mod
ine or other structure herein cfcser,
Shores Village, Florida. and alhpr
regulations of the Building Div
plans and specifications must be
BUILDING INSPECTION DEPARTMENT
PPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
for the approval of the detailed staten or me plans and specifications herewith submitted for the build.
d. This application is made in compliance and conformity with the Building Ordinance of Miami
isions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
cpt at building during progress of the work.
•
Date ..._..._ ».�G�G..»._. »_._ ..._... »._ r T. ».... v..�._.
Owner's Name and Address .........6 - / ._. No., ? »....... Street._.LI/'• • • ar1...'
Registered Architect and /or Engineer.••... I�f4fZe.V.e &h ..:.. ......:..•.,,.,. „,� „,.,<�
�� ?rr �1v J Gio -ril �E�' d�` 2 fmo? l
Name and address of licensed contr�ctor....��YL.S: � _» _. ».... ».... »...
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 bu ing b floors) rber.. �
..
(001 baovis
New Building
To be constructed of
I hereby submit �all plans and s c ifications for said building. All n
be sent to.. . e.... ..eecti
STATE OF FLORIDA,
COUNTY OF DADE. i ss.
Disapproved ... .��.�..: \/.:_ Date
(Signed)
Remodeling Addition
Building Inspector
/c90 Me.
(r jam, -c . itc
VAS' e �T
A't
Gxef•
X 00 vs-3s-u
Notary Public, State of Florida
My Commission Expires
1
and for no other purpose.
Repairs No. of Stories _
X2'1.... Kind oun oo CCovering
Estimate Total cost of improvements $ Amount of Permit S. v tj
Zone cubage required Plan Cubage
Distance .to next nearest building. Size of Building Lot
Maximum live load to be borne by each floor
es wit reference to the building and its construction may
fir/ 3.11 ��........
The undersigned applicant for this building permit does hereby crrtify 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 ork such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such ntractora on wok to •1 • j fo nder this
permit. as are licensed by Miami Shores Village.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
pea - -• — •• •
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 e e.
Permit No.._.. Date 10 ).. Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Chairman Member
\fcrr:ber M ember
\tcmber .. .. _.....__..._._._._._ .._._ 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 1'Linnir.g hoard.
A re inspection fce of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.