1200 NE 97 St (3)Application is hereby made fo' the approxal of the deviled stateniem of the plans and specifications herewith submitted for the build-
ing or o h, , .ructure her i described This t licatsc is made in compliance and con cum ty w.th the Building Ordinance of Mil ii
Shores Village, t .or da, and all pro isions of th, Laws i f the State of 1.1krid. all o d nances of Mi ni Shores Village and all rules yid
regu a'ions of the Building Div.. s of .i_im Sho. illage 1 '1 e - 'o , rpl ed with, whether herein specified or not. A copy of approved
plans and specificati ms roust be kc at bui,d.i.g durin,_ progress of the wcrk.
Owner' • Name and Address.
Registered Architect <md /or Engineer _ _ .
Name nd address of (icen•ed contractor _
Location and legal description of lot to be built on:
Lot. Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
New Building.
g --
To be constructed of
Estimated " .tal cost of improvements $..
Zone ^ubage required
Distance to next near:•st building. .
Maximum hvc load to be borne by each flour
Remodeling _ __ _ _ ____ ____ Addition
- - Kind of foundation _.__
hereby submit all the plans and sp•ci i••ations for aid building All notices with reference to the building and its construction may
be sent to __ __ _ __ .
The unde signed appli ant for th . s bu -iding pc• does hereby ceitif',
of 1• bor under he Florida Workmen':. Compc,isation Act bc•ng S ton -
and h s compl ed w'tli he ploy'aoos tla rcof, and will require s ou +as coi
in the wo k to he p rf med under th s pern it and ill post or caw, to
or otites as arc requir d by the Act. The u r it!ri d agrees to emplo)
permit as are licensed by M am, Shores N,
Remarks.
STATE OF FLORIDA,
COUNTY OF DADE. sS.
Before me, the undersigned authority, a notary public, duly authorised to adir.rister oaths
pearcd
and who, being by me first d lv 'worn, upon oath deposes and says that he is the _
of th abos de c ibed struction t, • 1 has careially read the foregoing application, and chat he did sign the same. and ' a
therein by him stinted are t: :e.
Permit No.
Disapproved . _.
(Signed) ___ _
Chairman _ ..
Member ._ . .
Member _
Council Approved
BAMI SHORES V LLAGE
UILDIN INSPECTION DEPARTMEN
FLBCATIDN FOR BUILDONG PERMaT
Date.
Subdivision_- -
■
Amount c Permit $.
_Plan Cubage_ -- -..
. -Size of Building Lot .
A
Member
Memb: r
Me- be
Datt Pi.,:; r.
Date
No ____ Street __
Repairs -
ti
Date
Notary Public State of Florida
;Bui?'ling Inspector My Cnin:nis don Ex _ .
PLANNING BOARD ....DATE
° l Read, Sworn to and Subscribed before me.
and for no other purpose.
No. of Stories
Roof Cov -ring _ _.
Le under.ta and accepts h:s .•bligations as an ci„t 4is r
Gh n led (j, :, al Laws of Florida P r an; n S ,t : , ent,
ran e fru:i ;,;1 contr,..ctorF or sub contractor, ini le h% 1 'i i
, ^ 'sted f r i. on the site +if the work i tni not e
.n :bt.oti'r ctors, on work to be perfi r d tier this
nd take acknowledgment ire nnall-
Date
ft r : t pro :.1 1, s 1 , u ',t.• ,red from
NOTE: A charge of $1.00 will be mare for snaking corrections c • -1, .nges to this application
the Planr ng Board
A re- inspection fee of $1 00 will be charged when such re- inspection is ma-: 1•
. rc: -es a; improper 'lobo. f; r lost,
materials and /or workmanship.
,19 . r
to me wel! known,
c ts
t• 1- or 1 i' ty
(,
■••■•••■•••••••••■■••T TIMM" wyryi
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