601 NE 96 St (5)Application is hereby made for the approyal 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.
- i2 . j-E -at-R .E+_ Se, o-J .
Ot*m s Name and Address...
Regilered Architect and /or Engineer... _
Name and address of licensed contractor_
Location and legal description of lot to be built on:
Lot__ Block
Street and Number where work is to be done
State work to be doe and ose in y floors).
P rp g (
-- --
and for no other purpose.
New Building .__ tts= Remodeling Addition Repairs__ No. of Stories
To be constructed of Kind of foundation __ Roof Covering.
Estimated Total cost of improvements $____. 0 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 fot said building. All notices with reference to the building and its construction may
The undersigned applicant for this building permit dot. hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act. being Sec :ion 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 su...ntractors, 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, ._ undersigned authority, a notary public, duly authorized to administer oaths and take atlaowledgments, 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 be has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. 1_
Permit No �i Date_._ -. r . Read, Sworn to and Subscribed before me.
Disapproved
( Signed) L
Chairman
Member __._—___..__
Member -
Council Approved
APPLLDC
......... Dat
uilding Inspecto
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
I4M I SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
TION FOR UILDING PERMIT
PL :+ ING BOARD
Dr _.. t . PJcS' . kA.) Iry die
Subdivision
.Date
® s °°6 . 19
Dat
�- _ -- Street --
.sue
Notary Public, State of Florida
My Commission Expires__
DATE
Member
Member
Member . _._ ... .
Disapproved
Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
.47 CT
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