1200 NE 96 St (7)STATE OF FLORIDA,
COUNTY OF DADE. j ss
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval 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 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' P
Owner's Name and Address. i_,/.9 C C.4'4 iacw4 y. No Street
Registered Architect and /or Engineer
Name and address of licensed contractor .1__,f _F G- / ?l? C I7 0
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ,1, e_
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation R f Pering
t2 c �°
Estimated Total cost of improvements $. _._ 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, 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
( Signed) - ''-'`
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 tro 4 Date Read, Sworn to and Subscribed before me.
Disapproved Date _'
i � � Notary Public, State of Florida
(Signed) 7,
Building Inspectorf \\ My Commission Expires
i
ANNING 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.
to me well known,
Owner' Name and Address
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det,iled statemen of the plans and specifica. ions herewith submitted fo: the build-
ing or o h. -ructure her r described This i-i licatic is made in compliance and con o'm ty w,th the Building Ordinance of Mia ii
Shores Vil1acre, or da, and all pro isions of the Laws c the State of Fb.rid. all o d nances ,,f Mi ni Shores Village and all rules and
regu a ion. of the Budding Div . 1 of •ram Sho. iilage } '1 a , o. ipl.ed with, whether herein specified or not. A copy of approved
plans and spccificati .m must be key at building durin progress of tl.e wcrk.
Registered Architect and /or Engineer._.
•
Name nd address of licensed contractor. �"� ' Ry_ -'�
Location and legal description of lot to be built on:
Lot ._.._______.._..__ _ _ Block.._ _._. Subdivision
Sheet and Number where work is to be done 42
State work to be done and - ; purpose of building (by fors)
New Building _ Remodeling_
To be constructed of _ - Kind of foundation ._ Roof Cov
i- Q
Estimated ".:tal cost of improvements $__ t Mount cf Permit $__
Zone ^ubage required_ __. _plan Cubage_.__.
Distance to next nearest building._ .. _ ___Size of Building Lot --
Maximum live load to be borne by each floor _ . _____
hereby submit all the plans and speciiications for said building. All notices with reference to the building and its construction may
bz sent to
Date
No
-
Street_
Addition____ ____ ___ _____ __ _ Repairs.. - _ No. of Stories
,19
and for rio other purpose.
The unde signed appli ant for th's building permit does hereby certify eiat he understands and accepts his .•bligations as an employer
of 1 bor under he Florida \Vorkineri s Compensation Act being S •tion 5968 Coi p led Gen al Laws of Florida P r anen Sipple Went.
and h s compl ed w :th he prov• cons thereof, and will require s'milar come lance from all contractors or sub-contractors emplo .ed by him
in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of the work su h public noti c
or •otic es as are requir d by the Act. The u. d. r ign d agrees to employ only such abcontr ctors, on work to be perform d der this
permit as are licensed by M am. Shores \ it : ge.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ..nd take acknowledgments, personally ap-
pearcd
to me well known,
and who, being by me first d. ly sworn, upon oath depowes and says that he is the
of ill abov de .c ibed . istruction t. . li has careially read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie.
! - •.� ,,
Permit No =?? Date__ ___ Read, Sworn to and Subscribed before me.
Disapproved Date__ _
' • . Notary Public State of Florida
(Signed) ___. ___
,wilding Inspector My Com:nission Expires_ -. - -
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 Ift.•r approval his been obtained from
the Planr ng Board
A re--inspection fee of $1.00 will be charged when such re- inspection is m .e necessary by improper notice fer inspe.•t or fa. Ity
materials and /or workmanship.