540 NE 96 St (19)M IAM lf` 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 building
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 regula-
tions of the Building Division of Miami Shores V:.11age 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.
Name and address of licensed contractor
Location and legal description of lot to be p bu ' ilt on:
Lot__ / / _ . L _ Block S/ .Subdivis'
!SINN,,,,,... Street and Number where work is to be done
i
' rate work to be done and purpose,of building (b•
Chairman
Member
Member
Council Approved_
Disapproved ___________
(Signed)
Building Inspector
Date /0
" f y�
Date
Owner's Name and Address / rZ1
Registered Architect and /or Engineer ;%/
Size of Building Lot
Remarks (Signed)
PLANNING BOARD_ DATE
L
Date. -1�_� ✓ 19
Street — <�
`
New Building___)( W______ Remodeling Addition
To be constructed Kind of foundation
Estimated Total cost of improvements $ / ^ .z—Y
Zone cubage required 2 f' G: LK r Plan Cubage
Distance to next nearest building
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
be sent to
The undersigned applicant for this building permit does hereby certify that be 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 public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Repairs
_Amount of Permit $
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STATE OF FLORIDA, I
COUNTY OF DADE.
Before me, the undersigned authority, a nota :y public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that be is the
of the above described construction, th he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are rue.
Permit No
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
No. of
Roof Covering__ _
_and for no other purpose.
Member
Member —
Member
Date Disapproved
may
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.
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved _______________ _ Date
(Signed)
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 building
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 regula-
tions 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.
_ ., Date_—___e_�L_�� `'—" 19_/
Owner's Name and Address '� " ° ° _ , "^- C. No.___ r 7 c) _ Street A.%" —
r /
Registered Architect and /or Engineer - .' - "!� ' Z' ___
/ 9II
Name and address of licensed contractor -�4. '- i'"�� % '
�d 'V / �_/ '� L_fl 0 Al �' •►
Location and legal description of lot to be wilt on: --•:: f -
Lot �� /l Block_„2__.L_�� Subdivision ,�
Street and Number where work is to be done i „ - 'i'') 7-
State work to be done and purpose f building (by floors)
New Building__ Remodeling_ Addition Repairs No. of
To be constructed of__ Kind of foundation _____ _ -_ Roof Covering__. _____ —_-___ _.
Estimated Total cost of improvements $ �f �' � �_ _�__�_Amount of Permit $ �t
Zone cubage required—__ 2 O B d 0 Plan Cubage %.,t' €.S
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, an 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 public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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 tt
Permit No 7e;) Date /L Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member _
Member Member
Council Approved_ Date Disapproved
Chairman
Member
and for no other purpose.
Notary Public, State of Florida
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval bas 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.
C