1298 NE 97 St (5)-,0 BA M SHORES INSPECTION o VILLAGE
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 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 ._..04 qt
Registered Architect and /or Engineer
Name and address of licensed contractor
Disapproved _,/ ____ . Dat
(Signed)
ui ding
NOTE: A charge of $1.00 will
the Planning Board.
A re- inspection fee of 51.00 wil
materials and /or workmanship.
e kJ
Location and legal description of lot to be built on:
Lot' a Block / Subdivision
Street and Number where work is to be done / / E ,
State workpi be doe and ur oose building (by floors)___
f c 4 Ad" , et S /e4 e i Z
Date /" — r P
Chainnan
Member
Member ...__...
Council Approved
92'
r
Date 4l mil! a 7
No
ector� °!/
t
PLANNING BOARD DATE
,' 19 63
Street /�/.e. 97 `�•,ff
' i! // 4/G1 <G o -F /
rle 7o/7 01
and for no other purpose.
New Building Remodeling Addition Repairs
To be constructed of___ Fr"a*7 _ e,. Kind of foundation __.__- __Re_rl: f- __.__Ce K C
Estimated Total cost of improvements $ /W b
Zone cubage required
Distance to next nearest building
No
Roof Covering
Amount of P €rmit $ 1D —'
-Plan Cubage 1 1 6 —
Size of Building Lot
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
. of Stories /
4 's Ur 5/3 r.7.ve
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 perinit 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 subcyrt)ractors, o w to be�perfor d er 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 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 -
Permit No. - - - --
My Commission Expires
Member
Member
Member
Date Disapproved Date
be made for making corrections or changes to this application after approval has been obtained from
I be charged when such re- inspection is made necessary by improper notice for inspection or faulty
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