1170 NE 97 St (5)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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 D v kept auildin
of Miami Shores during e lag sh b tco work.
complied whether herein specified or not. A copy of approved
plans and specifications must
� ao
Owner's Name and Address . k%) �� ', a hS N a e
Registered Architect and /or Engineer
Name and address of licensed contractor __== O-, s.-5'''----4._ — t
Location and legal description of lot to be built on:
Lot — Block Subdivision
Street and Number where work is to be done I t 1 ® — C4 • e7, 1 �? •
State work to be done and purpose of building (by floors) • 2 'E A. o Y C:
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
-1 c_,r,
Estimated Total cost of improvements $ - - ' v- 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 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, Pennanent 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 )-= `�'L I •
Remarks - - — -- l ?I_ Inc, � �
STATE OF FLORIDA,
COUNTY OF DADE. j ss-
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
MIAMI SHORES VILLAGE
Bu
Date
7.- a -
My Commission Expires
Street c•! F-
,19
` .`�.
Fc.. cR t ( e L- -i c" c..h E 4 &-G e' S .
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. �1
Permit No.— l�- �?-- `� -�-� -Z Date__
�� 1 �t r Read, Sworn to and Subscribed before me.
Disapproved
Date___ el .
Notary Public, State of Florida
(Signed) *x ector
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 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.
Date of fumigation noptemlun. 13,1968
Location of structure
Owner's Name and Address
Type of Structure
Approx. No. cubic ft.
0- County Health Dept.
He Shores
a
F U M I G A T I O N N O T I F I C A T I O N
1170 rl 07 St-
U.f. Adrhins
CTS N. Res.
37,000
Firm Name: TRULY NOLEN INC.
600 N. W. 7 Avenue
Miami, Florida 33136
Approx. time 12:3n P.N.
Name of Fumigant Thinle►tn
Length of fumigation period
Distance to nearest building over 10 Ft.
Certified (or Special ID.) Flmigator in Charge:
Name:q !ScCutchenn
Telephone: 177_1611
Day
751 - 1?_12
Night
FUMIGATION SHALL BE PERFORMED IN STRICT ADHERENCE TO THE FUMIGANT'S REGISTERED
LABEL AND FLORIDA STATE BOARD OF HEALTH RULES 1701 -2.
NOTIFICATION TO BE RECEIVED NOT LATER THAN THE DAY PRIOR TO RELEASE OF THE
FUMIGANT BY:
0- Fire Dept. 0- Other