546 NE 97 St (9)k
MIAMI SHORES VILLAGE
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 Ordirance 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 ccpy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address _ _,__'-_ ___ No. Street .. - L
Registered Architect and /or Engineer
Name and address of licensed contractor ;
Location and legal description of lot to be built on:
Lot __ ' ' _ ' _ ________— Block___ [' / -: Subdivision
Street and Number where work is to 15e done _1' / >'
State work to be done and purpose of building (by floors)
Bf11LOINL'. INSPECTION DEPARTMENT
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT/
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
New Building ______ _: ___. __ Remodeling Addition
To be constructed of .__ > __ Kind of foundation
Estimated Total cost of improvements $ _,_
Zone cubage required 1 ' :�
Amount of Permit r$
-- _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 ecnstruction 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 Supplenment,
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 Mspection 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 contractors, on work to be performed under' this
permit, as are licensed by Miami Shores Village.
Remarks (Signed
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 careful read the foregoing application, and that he did sign the same, and that all facts
therein by him tated • e true.
Permit No Q Date
Disapproved _ _____ + Date ,
(Signett) *. t
Building Inspector
Chairman
Member
Member
Council Approved ...___ Date
PLANNING BOARD
•
Date -
•
Repairs_ No. of Stories
Roof Covering
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
f My Commission Expires
DATE
Member
Member
Member
Disapproved
19
and for no other purpose.
to rte well known,
Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
___,A
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