622 NE 97 St (2)// 3) -' /H� 6
Owner's Name and Address
STATE OF FLORIDA,
COUNTY OF DADE. ss.
(Signed)
Disapproved 1 \ � ..- ..� Da e
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby umdc for the approval of the detailed statement or me plans and specifications herewith submitted for the build •
ing or other structure burin 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 iuilding 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 pragreu of the work.
Registered Architect and /or Engineer • •.. •. ••.... •... /�, ,.: ............... •,,., «n « «,.,.
Name and address of licensed contractor.... �li/L � ..4�f1. ./
Locati n and legal description of lot to be built on:
�
Lot.. 7 � ,!Y.� ...... . Block .� Subdivisio ' �
Street and Number w'ih work is to be done
State work tq o e and p osc of building (by floors). _ � ✓ .._..._.� $ >�?U_.._
ate..._.._... ��'L/ cs� 4 . -... .. 19 U
No... a� � . Stre� t 9.7
_..__ and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation R.• Covering
Estimate Total cost of improvements $ 2Z Amount of Permit S...
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..
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,
pleent,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub • tractors employe by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the siteof a work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontract rs, n work be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)...._ '.�- '... _t Ide
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 carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.. a ��
Permit No.. g Date "1/11 `7 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires _........_ _
to Inc well known,
PLANNING BOARD 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 been obtained fmtn
the PI.rnnir hoard.
A re inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
/1 9 7 ?"7/