1271 NE 97 St (4)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, whether herein 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 V f '.�_ C � a� s � ‘).
Name and address of licensed contractor_ __— _= ?_ ° __- 3_°��� " ° —
Registered Architect and /or Engineer
Location and legal description of lot to be built on:
Lot Block i` Subdivision e 6 '
Street and Number where work is to be done _4__,___:: -- r
New Building \7
To be constructed of
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SH ® RES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
State work to be done and purpose of building (by floors)
Disapproved' Date
(Signed) = — C� ��=
Building I nspector
Date_
and for no other purpose.
Remodeling Addition Repairs. No. of Stories Q
^° �� t Kind of foundation _ `" "' R
Estimated Total cost of improvements $ _____�__ q = ,) <% Amount of Permit $
Zone cubage required -• s a ', ," _Plan Cubage
Distance to next nearest building c L Co) 1 ti �� Size of Building Lot
Maximum live load to be borne by each floor ' ' —\
I hereby su b
y mit t all the plans and specifications for said building All notices with reference to the building and its construction may
a ..
be sent to `" + s —
n
[1\, _ . ,,,J,
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 or inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only suc ubcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed) _ '
c 457(C'' /3/
Street___1L/ ° • C /
`
C Covering
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 described construction, that h he hasccarefully read thb foregoing application, and that he did sign the same, and that all facts
therein by him st
Permit No
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLAN G BOARD_ __ll DATE
Chairman ' Member
Member Member
Member Member
,Council Approved Date Disapproved
4 ., Si OTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
tfq 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
4naterials and /or workmanship. •
Date