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622 NE 97 St (8)BUILDING INSPECTION DEPARTMENT P(LIC %' TIDN FOR BUILDING PERMIT 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 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 Building Division of Miami Shores Village shall be complied with, whether_ " -' ' d or not. A copy of approved plans and specifications must be kept at building during progress of the work. MIAMI SHORES VILLAGE . � �5 nn Owner's Name and Address_e.��i�" (UIIIU_. � (f' 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 be done '? �_, N E State work to be don and purpose of . "ldi (by floors) and who, being by me first duly sworn, upon oath deposes of the above described con tion that he has care ully r therein by him stated are , Permit No Buildi Disapproved ____ (Signed) Date., Date__ Date ' �✓� 19 No Street and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering 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 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, 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. 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 - to me well known, and that he is the_ d e foregoing application, and that he did sign the same, and that all facts Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires 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 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. 113'6 /77/'7_ e7L n MIAMI SHORES VILLAGE /fr '7' BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby sonde for the approval of the detailed statement 01 me 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 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 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 rogress of the oils. ..,1._._._...._. , 9. �� . R - 4�-�: a ....._ - 9 7 '-- Owner's Name and Address .722-:(2.s. _ No..�a.�.�._... Street�iC�• _ .... __ Registered Architect and /or Engineer ., ::. ,,,•••,,, •:,,,,f„tH„•,•H,,,,,, OTT Name and address of licensed contracto l g Location and legal description of lot to be built on: Lot Block p �/ Street and Number where work is to be done 2 -ate 717 , �� 7 .. � eQ State work to be done and purpose of building (by floors ,f - /ooh "A C'S?ta! (..4/22. X ` ' ' New Building Remodeling. / e To be constructed of Kind of foundation Estimate Total cost of improvements $..a`;.$g'Q' STATE OF FLORIDA, COUNTY OF DADE. ss• and who being by me first duly sworn, upon oath deposes and says that he is the. Subdivision and for no other purpose. Addition Repairs No. of Stories Roof Covering -6A /, % Amount of Permit S. Zone cubage required _Plan Cubage Distance .to next nearest building Size of Building Lot \faxunum live load to be borne by each floor • I hereby submit all the Rkins and specifications for said building. All with reference to the building and its construction may be sent to..� e)5en4 00 X=7 0 .77/0/ /V / -73 6 /14 /11/tit 33 /41.2/ 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;■Perrnxnent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the sit • the work such pu ,li • notice or notices as arc required by the Act. The undersigned agrees to employ only such s tr etors. on . •rk ? be performed it this pcnnit, as are licensed by Miami Shores Village. Remarks.. ....1P S 4,���� (Signed Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared .. t� sZd.e.7 -' s5.4e/7 LVAT2.26G7? A. .7 t;,t �i�orya.cp to me well known, 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. Permit No. cLL 2 SJ Date 3 /y10 Read, Sworn to and Subscribed before me. Notary Public, State of Florida \� Disapproved . IIP Date _ i ' \ 1 � (Signed) .. -• Building Inspector My Commission EspiTARP PUBLIC STATE OF AT LARGE es MY COMMISSION EXPIRES NOV 4 1985 PLANNING BOARD DATIVNDED THRU GENERAL INS. UNDERWRITERS 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 from the Planning ifoard. A re fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection at faulty materials and /or workmanship.