1298 NE 97 StMIAMI SHORES VILLAGE
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
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mr
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules an
regulations of the Building Division of Miarni 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 Wacire COint– _ C 0
•
Registered Architect and /or Engineer` 1WOFE0
Name and address of licensed contractor ( 'la
Location and legal description of lot to be 4 on: 4
Lot_ krk Block t t d1 Sub
Street and Number where work is to be done__ �
State work to be done and purpose of building (by floors ) _
Date
Chairman
Member
Member
Council Approved Date Disapproved
Itie• 23
NoQZ
PLANNING BOARD DATE
Street
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division Ew5 s2 tSo s
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c t K.LE Qcn l a_E ►Oe -
and for no other purpose.
No. of Stories
New Building N Remodeling
To be constructed of__ 52,is Kind of foundation 1_. .f�
,____c• Roof Covering _ \QE
Estimated Total cost of improvements $___ .S.,_QQ ___________________Amount of Permit $ 1_
Zone cubage required '' _______�_____ _Plan Cubage_
Distance to next nearest building �CC2- )L _Size of Building Lot
Addition Repairs
Notary Public, State of Florida
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 work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ubco ractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) _ _V
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 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 Date Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector My Commission Expires
Member
Member
Member
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
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.
100 . .
Date
has been obtained from
for inspection or faulty