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1196 NE 97 St4 k MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT AP'LIRATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regula- tions 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____ FL 19 Owner's Name and Address • • � s2_ l _____ No.l2 Registered Architect and/or Engineer - " g / g . Re Name and address of licensed contractor 1rn- ,- :>2 C` 4 4�9 � � ;�, ^ • � • •: Location and legal description of lot to be built on: Lot___ Block 1 Subdivision 5 Street and Number where work is to be done Cn. . t � 4 s. State work to be done and purpose of building (by floors) and for no other purpose. New Building____`s__= ____________ Remodeling____ __ Addition_ Repairs No. of Stories_ To be constructed of± M . Kind of foundation__ nom Estimated Total cost of improvements $ - - _Amount of Permit $ Plan Cubage - 1 k- * �� ,i L Zone cubage required_ + Size of Building Lot i _Lita ;\7•"-+ ` Distance to next nearest building Maximum live load to be borne by each floor 1 hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to C a '�.�. G 4 4� a8__ t1k�4 ��-a . ✓�, `�• 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, 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 work such public notice or notices as are required by the Act. The undersigned agrees to employ only such bcontractors, on work to be performed under Ibis permit, as are licensed by Miami Shores Village. § • Remarks (Signed) __ —' � STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared and who, being by me first di1y upon oath depose of the above described Construction, that he bas carefull therein by him stated are trcte. Permit No.___,_—,__ ___ Date__„_ Disapproved (Signed) ; -- fir __ ate 14 / •� -w ?j f/ uilding Inspector t A 1 ' r .1 ter' Roof Covering_ w-ais - -- �f- and says that he is Abe read the foregoing - application, and that he did sign the same, and that all facts v z / Y Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires__ —___— PLANNING BOARD DATE Chairman . Member Member Member Member Member Council Approved Date Disapproved 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. to me well known, 'Date iA - L. , , r • 1 t ' --- 1.. 11 1 • f (_ i • t 11W Application is hereby made for the approval of the detailed statement of the eJans and specifics bons herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Builui.:; Ordinance of Miami Shores Village, Florida,•und all provisions of the Laws of the State of Florida, all ordinances of Mimi Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein ;pecified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Lot --_-___— ____ -__ Block BUILDING INSPECTION DEPARTMEN APPLICATION FOR BUILDING PL RMIT STATE OF FLORIDA, COUNTY OF DADE. ss. MIAMI SHORES VILL Registered Architect and /or Engineer Street and Number where work is to be done State work to be done and purpose of building (by • floors) — No. ___t Street Date , 19 6 Name and address of licensed contractor : -- � w Location and legal description of lot to be built on: Subdivision and for no other purpose. Repairs No. of Stories // New Building Remodeling Addition To be constructed of ` __.% '__ Kind of foundation �/ " = ^ - Roof Covering Estimated Total cost of improvements $ / / " i Amo t 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, 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 postedJoi spection 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. / Remarks (Signe 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, u on oath deposes and says that he is the of the above described construction' that le 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 . A Date / Disapproved i Date (Signed) - Building Inspector __ . ' Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD l 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.