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1260 NE 97 StLocaxinnn tTgab d©iip Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor 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, whethe>j \ herein s ified or not. A copy of approved plans and specifications must be kept at building during progress of the work. • t , 19_ �o Str APPLICATION FOR BUILDING PERMIT Street and Number where work is to be done_ State work to be done and purpose of building (by floors ) _ STATE OF FLORIDA, COUNTY OF DADE. j ss. and who, being by me first duly sworn, upo oath of the above de cri)aed construction, that he therein by him fated are true. Permit No .A_ ( �/ Disapproved c' -' Date \ (Signed) ' ^ ` ; ��� � MIAMI SHORES VIA-AGE BUILDING INSPECTION DEPARTMENT lot Block be lock )?uilt on: Sub dlvision_n` Building Inspector qt- eposes and says that he is the refully rd the foregoing application, n ;_ Read, Sworn to - - -- and for no other purpose. New Building E,--,--- Remodeling Addition' Repairs No. of Stories / r / To be constructed of til -, Kind ` foundation 1.- J ''', , ' Roof Coveeiing 1 .4- Estimated Total cost of improvements $_ _ ) �' ' c _________________ Amount of Permit $ f i r _ Zone cubage required L . 9 6' �� flan Cubage E ,� ,0 i �-, ,' Distance to next nearest building ', i Size of Building Lot �j Maximum live load to be borne by each floor Ta' eet 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. 4 - Remarks (Signed) ___.__ �r Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared to me well known, and that he did sign the same, and that all facts and Subscribed before me. Notary Public, State of Florida My Commission 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 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.