357 NE 97 St (10)MIAMI 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 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 budding during progress of the work.
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Owner's Name and Address eV \x ‘. 5 � �.... ` .....� .�^.t .l� � CA? No ..... . Street35a
Registered Architect and /or Engineer
Name and address of licensed contractor d"5:3 N
Location and legal description of lot to be built on:
V,6 Block Subdivision a '' "
4 . .. oc
Street and Number where work is to b onl :
building (by floors)
State work to be done and purpose of
b_tr2.1a,
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation
Estimated Total cost of improvements $.P_ . S _Q. ....ISO •OQ_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. 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 nubile notice
or notices as arc required by the Act. The undersigned agrees to employ only such sub = factors, ors war:: to Se gforrned under this
pennit, as are licensed by Miami Shores Village. \
Remarks (Signed).. • _ N cCL`�__
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take cc:tnowledgments, 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 the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true
Permit No __� �_ Date 2
Disapproved
(Signed)
Da�
ing Inspetr
PLANNING BOARD DATE
Chairman
Mcmbcr
Member ......
Council Approved
L FA- jj o v L___
•t . Y "•••SSSSSS!t
NOTE: A charge of $1.00 will be made for making corrections CT chnnges to Ws a;sp:icotion nitc4 apin-ovp2
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is r:*.a:7/e c.s ?.ssry by frer,.;.-iu rrc ee
materials and /or workmanship.
Read, Sworn to and Subscribed before me.
cu CQ erd
1. .-
Notary Public, Stnte of Florida
My Commission Expires
to me well known,
Mcmbcr
Member
Member
Date Disop;grcvez Date
has Preen obtained from
for inspection or faulty
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