278 NE 97 St (9)MIAMI SHORES VILLASE
BUILDINV- INSPECTION DEPARTMEN
APPLICATION FOR t!LIILIDI
Application is hereby made for the approval of the detiled statement of the plans and specifications herewith submitted for the build-
ing or o.her structure her. L described This n.licatio i is made in compliance and corrorm ty with the Building Ordinance of Mia ii
Shores Village, Fior da, and all pro isions of the Laws c f the Stmt.. of I. lurid.. all o d-nances uf Mi in Shores Village and all rules and
zegu'alion: of the Building Div.:. :1 of . a im. Shm . ' illage I- 'I ,e ^m iphed with, whether herein specified or not. A copy of approved
plans and specificati nv4 must be lcti. at buridtrig durin, progress of the wcrk.
19 Date :- .---- ----..:___, 1: , ..•
'. ' T
Owner': Name and Address_ ,.))' ‘,. -'-' ....:;"- , \ No Street.
Registered Architect and/or Engineer _
Name rd address of licensed contractor
Location and legal description of lot to be built on:
Lot. Block. Subdivision
—
Street and Number where work is to be done.
State work to be. done and purpose of building (by floors)
•
PERMIT
„„)
t _
•and for no other purpose.
Addition _ No. of Stories
New Building. Remodeling
To be constructed of - Kind of foundation ----------- - --- Roof 'ring
”
7 - " , ,,,,
Estimated " ,tal cost of improvements $_. ( -- '' ' Amount c, Permit $._
Zone ^ubage required ___ _Plan Cubage_
Distance to next nearest building.. . _Size of Building Lot
Maximum live load to be borne by each floor
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 unde signed appli -ant for tlis bolding permit does hereby certify i'lat he understands and accepts his obligations as an employer
of I. bor under he Florida Workmen's Compensation Act bc;'ng S .'ton 5966 Cm p led Gen al Laws of Florida. P r. linen S.ipph pent,
and h s compl ed Wth he prov• :ions thereof, and will require sq-nilar corm lame from all contractors or sub-contractors cmplo .ed by him
in the wo k to be p rt med under th s pern it and ill post or cause to bc posted for inspection on the site of the work such public noti e
or otices as are requir d by the Act. The u. d.r ign 11 agrees to employ only such obcontr- ctors, on work to be perform d der this
permit as are licensed by M am. Shores \ ge.
Remarks. (Sigled) -
STATE OF FLORIDA,
COUNTY OF DADE. ss '
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,nd take acknowledgments, personally p -
peaPad
--- -------------------- - _ _ to me well known,
and who, being by me first d lv , zworn, upon oath deposes and says that he is the
ot th abov. de t. ibed istruction t. . 1 has carerully read the foregoing application, and that he did sign the same, and that _11 facts
therein by him stated are tr ie.
' 9 /
Permit No.._ _ .( _ . Date_ . _____ Read, Sworn to and Subscribed before me.
Disapproved . Date_
(Signed) _ _ -
Build*g Inspector
Notary Public State of Florida
My Commission Expires.
PLANNING BOARD DATE
Chairman ... Member
Member _._. Member
Member _ _ Member ... •_ •
Council Approved Date Disapprov Date
NOTE: A charge of $1.00 will be made for making corrections or Aianges to this application iftcr approval lys be n obtained from
the Plane ng Board .
A re-inspection fee of $L00 will be charged when such re-inspection is mi ie nt;.es.ary 1 improper notice ft r imp t or It ty
materials ann/or workmanship.
Date r?/ ID/q2-. Job Address 2,1 2 N i= c ) 1 3 r f Tax Folio - 3 2.0(e - (01 3 - 3 91
Legal Description i of 3 w 1/2. koI- y B/k 30 al lam) 5hor. °5 Sec. I 4Ync( ?
/ Lessee / Tenant ?a+-rl cic.,- E . Dcl 1't n 2. Master Permit #
Owner's Address 2 18 N r 9 1 54
j e
Contracting Co----- ( ;7 c
QualifieriC- � , .,�
- - Phone _705=
Pri typ o ®
Personally known
Ty?e and number
ii NOT tltke an oa;h.
Zoning Building
Mechanical �Ha bing
Phone 757- 3 35
Ins.Co.
Signature of •ntractor or Owner- Builder
Dat
N
y�s�rp °ntractor or Owner- Builder
��btri ��r:d.�E"xpi re s
Cormrnisnm E; r B
y
S on d Pro SicrnWar: ztos a S t
* *
k
t
C.C.F, I NOTARY 5415 TOTAL DUE �
Fire Other
Electrical
Engineering
o t
to Lohonrr ma
Ccfoe Ccz:Qe .qZ 41
e„ coLl pL
a.� � e.�nd� onr� Lo2s
s� c�- ' °the. 1 � ne, re�c�e�c;.
Ccaary\E_Qatao
I 0
.90
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