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1170 NE 97 St (4)MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby wade for the approval of the detailed statement cm 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. Date ...._....___. _ 1a /a. ? ,19 ? Owner's Name and Addres0A • &r / .'?/�e/ !� .>�d ... No Street Registered Architect and /or Engineer ,/ Nacre and address of licensed contractor. ®._.11�d.<1 . L9... >q3 /'r 44dZil 4rdaC 4 d-e Location and legal description of lot to be built on: Lot Block Subdivision // Street and Number where work is to be done... �...4�?`.._ ems.. /G_ S 2.L!`�.... �� State work to be done and purpose of building (by floors) _.._. and for no other purpose. New Building Remodeling Addition Repair; No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ . U° 6 3 P b Amount of Permit 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 building and its construction may be sent to. The under>igncd applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labur under the Vlonda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Snp m deent, 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 arc 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. /,/ /�, ,, (!�'��r..C.� =E3.s� 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 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. y Permit No k°I. Date ��� ......._._ Read, Sworn to and Subscribed before me. Disapproved Date Notary Public, State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member \Icu ber 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 Plannir.;; Board. A rc- tnspe4 tion fee of $1.00 will be charged when such re- inspection ix made necessary by improper notice for inspection or faulty materials and /or workmanship.