1229 NE 97 StPLANNING OARD
Chairman
Member
Member
Council Approved Da
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 Miarni 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 , 19_6_20 Owner's Name and Address______ — a- w ✓ / No / 0 / 6 6 Street Ar E II. A- e/ e
Registered Architect and /or Engineer 1 "J'Z- 1_4-- 2-'0,-,-.),-.0 / o r �
Name and address of licensed contractor________________ _> r ___C4 - _S f CS? 3/ G s G �+ °�'� a t / o 3
Location and legal description of lot to be built on:
Lot j___3 Block 3 Subdivision ._ ___ k_ 4 f / ° 716 7-0 � o 0-6, 5
Street and Number where work is to be done ,-__C__ _� 0 1 ,____1 = �
---- --- - - - - --
State work to be done and purpose of building (by floors) /?Ce. S e ei e7.. e cc
--- - - - -.. and for no other purpose.
New Building t./ Remodeling Addition Repairs No. of Stories 1
To be constructed of C-- 6 S Kind of foundation Co -A., C. Via,,
nt Roo Covering t/ /e
,
Estimated Total cost of improvements $ 1 ��-- .5,x_ 0 0 Amount of Permit $ 1L_ ' ° ` _
-� - - Y ,
Zone cubage required _ f3 r _Plan Cubage c ._ �___-. ------'-----r---;
Distance to next nearest building Size of Building Lot 7_s! ____ X_____ ___ o__bs'
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 . / - - 2 - � C c -, i C 7` _ 47 i y i.z ,' N • 4 ! c .fir 3 ____ _____ ----- ----- --
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 Law;; 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 t e work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subc9ntractors, on work to'( be performed under this
permit, as are licensed by Miami Shores Village.
Remarks_ (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
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, upon oath deposes and says that he is the
of the above describe.: qnstruction, that he efull read the foregoing application, and that he did sign the same, and that all facts
therein by him state are tide. _
U % A--> /->e)
Permit No Date__ Read, Sworn to and Subscribed before me.
Disapprov /Date
r ; �� A \, Notary Public, State of Florida
(Signed_ r,' 1 � ,.
Buil. mg Inspector I My Commission Expires
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 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.