623 NE 97 StAPPLICATION FOR BUILDING PERMIT
.Application is hereby mode for the approval of the detailed statement or see plans and specifications herewith submitted for the build
ins 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 Miaml 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 progress of the work.
Owner's Name and Address A . L . C.'A H
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 cp 2 q r i
State work to be done and purpose of building (by floors).....cO!`LST2vCT M�
A5 Pt4 Q L 1- 3 tvq..\4Alk C N .4 4,"
New Building
To be constructed of
Disapproved
(Signed)
ss.
Estimated Total cost of improvements $ 2 --®O • b
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date ..._..._...— ......r..�._...1 ® c................... 19.5.1
._ No..‘ : .. _.. Street PA �, 9 _5 -1'a2 1
LA -% A I�� PA.vt t4
peared
.t .A.t�rl.t �• 3 .k ......
. et.ure.At+s4>Te
and for no other purpose.
Remodeling Addition Repairs No. of Stories
Kind of foundation Roof Covering
•
Amount of Permit S.
Zone cubage required _._.._....Plan Cubage
Distance .to next newest building Size of Building Lot
Miaxirnum 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 and
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compil
and has complied with the provisions thereof, and will require similar compliance from
in the work to be performed under this permit; and will post or cause to be posted for
or notices as arc required by the Act. The undersigned agrees to employ only such su
permit, as are licensed by Miami Shores Village.
Remuks __._.__ (Signed). _....
\/1 Re 1 ,xtaT
and accepts his bligations as an employer
el}al Laws Of Flori a, Permanent Supplement,
atractors or sub -colt actors employed by him
tipnon the site of work such public notice
s, on work to performed under this
Av r
Co. I
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
ap-
to me well known,
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..
Permit No.. ..0 3 ..1).4. .4. Date .. tr -?-`1 Read, Sworn to and Subscribed before me.
Date
Notary Public, State of Florida
Building Inspector 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 1 o.ird.
A re- in %pcction fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspections or faulty
materials anti /or workananship.
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