1201 NE 96 St (9)APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed state rnt os me 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 orl not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owners Name and Address27 °v.iP'-S v7C NEn
Registered Architect and /or Engineer
Name and address of licensed contractor... .. , ,t:Ii1.C�L�.,�.... .A.U.I.C" � �1..�..s/ � ..�._..tl.&.Fi!9,4. - _
Location and legal description of lot to be built on:
Lot / 7 Block g 3
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building 4...---- Remodeling Addition Repairs No. l of Stories _
To be constructed ofe»'9 Gi.ti/c Kind f foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $..AU i
Zone cubage required Plan Cubage
Distance .to next nearest building.. Size of Building Lot
llaxirnum 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 Sr;p ileent,
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 subcon aetprs, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
4:,
STATE OF FLORIDA,
COUNTY OF DADE. i ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowl dgments, personally ap-
peared
_ 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 aref lly read the foregoing application, and that he did sign the same, and that all facts
therein by tea
14 6
Permit No.._. -+ E Date
Disapproved... Date
(Signed)
Building Inspector
Chairman
Member
Member —
Council Approved Date
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Subdivision .G� a . 3 'GA? Box /ei-3 2 .�
/2 0/ _. ! S i .. __...._.._
PLANNING BOARD DATE
No..a0/ NL . Street._..9
A�fD
° . Set
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
Member
Member
Member ...._
Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after apprrnal
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice
materials and /or workmanship.
Date
has been obtained from
for inspection or faulty
� 07 /7;E69
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