320 NE 96 St (7)MIAMI SHORES VILLAG
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING
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 hgrein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Disapproved ____ _ Date
(Signed)
Chairman
Member
Member
Council Approved
Building Inspector
New Building Remodeling 1 Addition.
To be constructed of Kind of foundation
PLANNING BOARD_
Amount of Permit $
_Plan Cubage__
Size of Building Lot
The undersigned applicant for this building perm' t -dot 'here l certify that
of labor under the Florida Workmen s Compensation Act, being Sec :ion 5968,
and has complied with the provisions thereof, and will require similar co
in the work to be performed under this permit; and will post or caus
or notices as are required by the Act. The undersigned agrees to em
permit, as are licensed by Miami Shores Village.
Remarks__ -
.Date
•
Owner's Name and Address._. 0AL rb77,2 . LR VL __ _._._______ No.. -_ - -- Street__.
Registered Architect and /or Engineer.__ _7 - T7 11
Name and address of licensed contractor_. 0.)/FRSE,/4 .6 -.. LT / cl�(P__ 41/C.
Location and legal description of lot to be built on:
Lot__ Block - Subdivision
Street and Number where work is to be done s3ZU fe.____ �� 57
State � work to be done and purpose of building (by floors)...
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building__
Maximum live load to be borne by each floor.__
I hereby subjt all the plan ecifications foi jd building. All n 1ices with refer
be sent to___/ /_ IJ _,e
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths
peared - -
Date /--- < - -- - - --- ( c 71— , 1 /
c �o S7
and for no other purpose.
Repairs No. of Stories
Roof Covering ....._..
e to the building jd Is construction may
cep -
he und4rstands an `l a pts his obligations as an employer
Compiled General Laws of Florida, Permanent Supplement,
all contractors or sub - contractors employed by him
nspectio, .n the site of t - work such public notice
ntr . • .rs, on work erformed under this
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.
Notary Public, State of Florida
My Commission Expires.
DATE
Member
Member
Member
Disapproved
'7
VERSEAS HEAT PUMP
K 157 Harbor
F Drive
ati� a1' 8 S IXowre3gmenfs 1pe ap-
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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.