1250 NE 97 St (10)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 iuilding Division of Miami Shores Village shall be complied with, whether }yerein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be byilt on:
Lot._ _la Block Subdivision
Street and Number where work is to be done
State work to a dyne and purpose of building (by
v2/ l)11 a /4 A
New Building Remodeling
To be constructed of S Kind of foundation
Estimated Total cost of improvements $....11,. � t3 0. a
Zone cubage required
Distance to next nearest building
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 wor uch public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco ctors, on yyorlyto be .rmed under this
permit, as are licensed by Miami Shores Village.
Remarks..._ (SignedJ../
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persortally ap-
peared
to me well known,
Disapproved
(Signed)
GailOAMO SHORES MOLLA E
BUILDING INSPECTION DEPARTMENT
APfPL00111OIN FO LELA:311Na PC G N117
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.. 2- 3 J _ Date 2 ��� p y Read, Sworn to and Subscribed before me.
Building In
■
e
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
ector
ors)
Date. /. ,19.71
No.fc..S treet_
Amount of Permit $
_Plan Cubage 8 I
G
__Size of Building Lot �a / 1. 7 /0c
/6"4rV Sif?®A-15'
7 :7'
and for no other purpose.
Addition
Repairs No. of Stories /
Roof Cover L:(4.
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.
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