301 NE 96 St (7)Application is hereby wade 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 / No -
Registered Architect and /or Engineer
Name and address of licensed contractor ...U.. C-44 -. .
Location and legal description of lot to be built on:
Lot Block Subdivision _
Street and Number where work is to be done. / 1(/
State work to be done and purpose of building (by floors) ..//2-C L'
be sent to...Q - C..,p12., Z. TNe,
Permit No.
Disapproved
(Signed)
MIAMI SHORES VILLAGE � c c r( l/
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
Bui • g Inspector
(Signed)
7,93 7.
call_ /vi T
and for no other purpose.
New Building Remodeling V Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ li ® ®U rZ
Amount of Permit S.
Zone cubage required plan Cubage
Distance to next nearest building. Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. A notices with reference tot building and its construction may
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, Pe manent Supplement,
rs employed by him
ork such public notice
performed under this
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contrac
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the
or notices as are required by the Act. The undersigned agrees to employ only such su '•rs, on woe
pennit, as are licensed by Miami Shores Village.
Remarks
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
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 theJegoing application, and that he did sign the same, and that all facts
therein by him slat d
7 __.. Date. /
Read, Sworn to and Subscribed before me.
to me well known,
Notary Public, State of Florida
My Commission Expires _ .. _ _ _ _ — — —
PL, NNINC BOARD DATE
Chairinan Member
Member Member
Member sass.. 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 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.