770 NE 97 St\_7; CO 5
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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. /
Date r f ! , 1
Owner's Name and Address______ __ � ' " __ - No ell Street
Registered Architect and /or Engineer 21!-7-t /. -, ?, 2,4.-A
Name and address of licensed contractor
Location and le al escrintio f lot to be built onl�
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Lot ° Block l0 1 Subdivision_
MIAMI SHItIRES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Street and Number where work is to be done «-
State work to be done and purpose of building (by floors)_ _— _____
New Building Remodeling Addition
To be constructed of C 0 - Kind ��ojjf foundation__ �?
Estimated Total cost of improvements $ 7
Zone cubage required _z_51
Distance to next nearest building
Maximum live load to be borne by each jlo4
I hereby submit all the plans awl spec ions for said building. All notices with reference to the building and its construction may
be sent to
STATE OF FLORIDA,
COUNTY OF DADE. ss.
therein by him sta
Permit No
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 ;Corirpensation 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 tli'e Act. The undersigned agrees to employ only such subcontractors, on work to b .performed under this
permit, as are licensed by Miami Shores Village.
Resparks_., 1 ( Signed)
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, oa deposes and says that he is the
of the above described construction he his -+} efully rread foregoing a1plication, and that he did sign the same, and that all facts
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Read, Sworn to and Subscribed before me.
ed are true.
O
Disapproved ate _
(Signed) /
Building Inspec or
Chairman
Member
Member
epairs No. of Stories
Roof Covering ,1 - -
Amount of Permit $ i'.69 .
_Plan Cubage 1_ S , 2-'
_Size of Building Lot > A. 1/ .5
PLANNING BOARD lL DATE
Notary Public, State of Florida
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eir
and for no other purpose.
y Commission Expires
ember
ember
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.