622 NE 97 St; -
d
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.
// _C �.� te�rr -- IF
Ownei s Name and Address 'V / _.2 ___Q • Registered Architect and /or Engineer '44L[1 D • (!t -CEO
Name and address of licensed contractor � . • d �/ 440
Location and legal description of lot to be built on:
Block-_..Lati._______ Subdivision
Street and Number where work is to be
State work to be done and purpose of building (by floors)
1 k
•-------------- ----- - - - - -- ----ter
New Building it Remodeling
To be constructed of______ Kind of foundation
Estimated Total cost of improvements $ ® _Amount of Permit
Zone cubage required �� 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 construction may
be sent to
STATE OF FLORIDA,
COUNTY OF DADE. f
and who, being b
of the above desc
therein by bite s
Permit No.__
Disapproves
(Signed)
Chairman
Member
Member
Council Approved
APPLICATION FOR BUILDING PERMIT
• Date__ - .
u 1
Building Inspector
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1
materials and/or workmanship.
MIAMI alHrIRES VILLAGE
BUILDING INSPECTION DEPARTMENT
1 - 4„." _ e.Y
__and for no other purpose.
Addition_______________________ Repairs No. of Stories_ __ _ " <_
6. •
oring_ __�nfi
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 —t9 be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) -
4
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and
appeared
ead, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Member
Member _
Member
Date Disapproved
Notary Public, State of Florida
My Commission Expires
take acknowledgments, personally
m first
bed con
ed are
to me well known,
application, and that he did sign the same, and that all facts
_Date
making corrections or changes to this application after approval has been obtained from
.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty