1099 NE 96 St (11)MIAMI SHORES VILLAGE // 3)z) 4 /L I
3 C5'
APPLICATION FOR BUILDING PERMIT ,S
Application is hereby made for the approval of the detailed statement ol toe Mans and specifications herewith submitted for the build
ins or other structure herein described. This application is made in to and conformity with the Building Ordinance of Miami
Shores V Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
complied regulations of the Building Division of Miami Shores Village shall be with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
t
Owner's Name and Address
BUILDING INSPECTION DEPARTMENT
5._„C No42 Street,c - -.
Registered Architect and /or Engineer
Name and address of licensed contactor
Location and legal description of lot to be built on:
Lot Illock Subdivisio .. _...___..._._ _.
Street and Number where work is to be done 45
State work to be done and purpose of building (by floors) _.>!0 C-/' - .. -- ._ - .
New Building Remodeling
To be constructed of
Estimated Total cost of improvements $..•. Amount of Permit 5..9.06
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
be sent to
The undersigned applicant for this building pennit 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 kith the provisions thereof, and will require similar compliance from all contractors r sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted • rnspe•tio r e site of the w such public notice
or notices as are required by the Act. The undersigned agrees to employ only s on work' to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Sig
Kind of foundation
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly aut • orizcd to adman er oaths and take acknowledgments, personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and 'ays th
of the above described construction, that be has carefully read the • egoing application, and that he did sign the same, and that all facts
therein by him stated are true..
Permit . . 0 Date 3f�
Disapproved ,�,��► ilk Date
(Signed) 1.
Building Inspector
. Chairman
Member
Member .. _..... - .._. ...._.......
Council Approved Date
49
and for no other purpose.
A
Repairs
Roof Covering
e is the.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
No. of Stories
to the building and its construction may
to me well known,
PLANNING BOARD DATE
Member
Member
Member -- • -• - -•-
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 Pi.rnnir,g 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 workinanship.