680 NE 97 St (3)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 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_ ( 4 M �5_._H_ A) -�_I 'raj 4QY No.____ O street___I�1____E_.__j 1 Si .
Registered Architect and /or Engineer_ ___
g Om�1°t 5 5__so r.-.. n,
Name and address of licensed contractor _'L_Y___IC__t __ � _t2__'_q__�4'' 1 1 5 t lY d 64- S .
1
Location and legal description of lot to be built on: Se C • 4 Lot_S i t__�. Block____. Q 0 Subdivision__. _1[t!1-_e-i1- . P__�_1 _a o f H 1a_ti 4 _I 5_ _o_re
Street and Number where work is to be done_ ___.( e?___ N:__E_. °L1 t 5 • t1 t a_ h_f S_lq_o_Y_
State work to be done and purpose of building (by floors) __ .,. e • tL • 5___ C9 _ a_Yr_ 3 _ 1 e. Pt SJ.s� j.4_1 !L_1ti
V85 and for no other purpose.
Addition Repairs No. of Stories 1 ,
r/i__e _v}_'' Roof Covering
Amount of Permit $ / � �
New Building Remodeling
To be constructed of__C S Kind of foundation
c►o
Estimated Total cost of improvements $__1__0_116
Zone cubage required
Distance to next nearest building
Permit No
Disapproved
(Signed)
(.1q
Date
IAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APP !CATION FOR BUILDING PERMIT
- 9-67 S
Date
Date M
Read, Sworn to and Subscribed before me.
- ( j
P
O
_Plan Cubage
o S .
ize of Building Lot ____ t__312___ __.t 0
> 19_6.
D
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 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.
Notary Public, State of Florida
Building Inspector - My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Datr
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained fr
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
materials and /or workmanship.