357 NE 97 St (7)0
ruANO H ®RES V i—AGE
.®@ ONSIPECT1ON DEPARTMENT
APPLIM .TIO a F! R (JILDELAG PERMIT
Application is hereby made for the cppro\'al 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.
y alA
Owner's Name and Address__ -- ?7 Zne.d.12.. s----- - - - - -- - -- - - -- - -- - - - - - -- No._._hr_ 2 Street_ - - Z.• ?L44 ._
Registered Architect and /or Engineer._ p,
Name and address of licensed contractor__O„ti uLrk6._ CsA,ti1_ , - - - - w- -C 9 0
Location and legal description of lot to be built on:
L Block Subdivision bi . A _. q
Street and Number where work is to be done 3__J -' / _JCS_• 1__9 •
State work to be done and purpose of building (by floors)
/ - A) P 4a_Q' n d 0“ - z g_ - -Q Qc) __d f.
and for no other purpose.
Disapproved
(Signed) --
Building Inspec
PLANNING BOARD__ ...
.Plan Cubage.
Date - — , 19 76
Size of Building Lot___
Notary Public, State of Florida
My Commission E x p i r e s
UL) 14v
New Building Remodeling Addition Repairs__ ___ No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ "1C e0 _D Amount of Permit $ 110
Zone cubage required
Distance to next nearest building_
Maximum live load to be borne by each floor_ . - - - --
I hereby submit all the plans and specifications foi 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, Comp . General Laws of Florida, Pennarent Supplement,
and has complied with the provisions thereof, and will require similar compliance f :in a 1 contractors or sub - contractors
in the work to be performed under this permit; and will post or cause to be poste for inspection on the site o the work ch public notice
or notices as are required by the Act. The undersigned agrees to employ only s subcontractors, on work y be performed under this
permit, as are licensed by Miami Shores Village.
Remarks -- -- - - - - -- - - (Signe. - - - �� �/ _!
Iploy by him
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 true.
Permit No.../. a - - - - - -- -- - Date___ -. 7d - Read, Sworn to and Subscribed before me.
DATE
Chairman _ Member
Member Member
Member 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 h obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper not e n•: in > n or faulty
materials and /or workmanship.