500 NE 96 St (6)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement us inc plans and specifications herewith submitted for the build
inc or other structure herein described. This appli ration Is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and all provisions of the Ltws 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 c uring progress of the work.
Date. 1 C FE°R ' ^ L
Owner's Name and Address ..P 1�,�tCa.......0.4026-
Registered Architect and /or Engineer ,,:,, ,,,•• ..,,,....•. ft
Name and address of licensed contrtctor......; �i:..... .....�,...0 .........: SI_:.:.
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done S &C) / _ �.�
State work to be done and purpose of building (by floors) �&O i ••. D .
Disapproved
(Signed)
Date
r #V t
Building Inspector
PLANNING BOARD
C'hair;nan
Member
Member .. .. _...._..._.._
Council Approved Date
Readvorn to acid Subscri
otary Public, State of Florida
My Commission Expires
Member t 1
Member
Member ...._
. . Street_....
before me.
It
Xit //fig
.33/.fs
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories f
To be constructed of Kind of foundation Roof Covering 5 15rte1
Estimated Total cost of improvements S•.... 6 5"ee.). D t) Amount of Permit S. U
Zone cubage required .Plan Cubage
Size of Building Lot
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby ubmit all the plans and spcVicationm for said building. All notices with reference to the building and its construction may
be sent to. . .
� L�tt-4%t -4 / 'f f.� ,/561, : : 2 et C !.'1 /�4 .3 S
i. '
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The u e crsigncd applicant for this build Kg pct`mit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compcnsat on Act, being Section 5966, Compiled General Laws of Florida, Permanent Snip plemeent,
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 in p , • n on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su ctors, • ; work , o formed un • this
pcnnit, as are licensed by Miami Shores Village.
Rem.uks (Signe�
STATE OF FLORIDA,
COUNTY OF DADE. ss•
Before me, the undersigned authority, a notar ' 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 oat}. deposes and says that he is the.
of the above described construction, that he has ci refully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true..
Permit No 333 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 llo.erd.
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 anti /or workmanship.
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