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775 NE 97 St (11).c4:7 Owner's Name and Address___ Peget170.11 Registered Architect and /or Engineer Name and address of licensed contractor_ ____ Z- /i Location and legal description of lot to be built : Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors)_____ MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDINIM 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 herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date /// ,, 19 f No � Street �/J_Ea and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of founds »on Roof Covering Estimated Total cost of improvements $ !l �� —� 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 ccnstruction 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 s_ • _ ontractors, •r. to be performed under, this permit, as are licensed by Miami Shores Village. AP 7 Remarks____ (Signed) STATE OF FLORIDA, COUNTY OF DADE. j 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 h carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. p / Permit No _ Date 1! 6 r Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector My Commission Expires Notary Public, State of Florida 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. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION 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 herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date OCtob2 ' 25 , 19 52 Owner's Name and Address.__ ..... Il ilUiE> s Job No 775 Street 1 9 Ste ft gigram bt o b itnacinu t catzipiaa 19 Av & 239 St Name and address of licensed contractor Calole ;JQQd Company 290 M1 73 St. Mi iii, P11a. Location and legal description of lot to be built on: Lot.._21 _..5__ ___x! Block 70 Subdivision.___.. Street and Number where work is to be done 775. N .o State work to be done and purpose of building (by floors) inst , ,2,g;tion-_o¢ -- -,g a __Si _ 4.8®x1 4 Tom 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 $.___ia99m00 Amount of Permit $ _.1 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 cons :ruction may be sent to cal,d2r'tood.._ ompaay 2 .90_ _. __7 z �__.S a 1a ¢ ..Rionida Easame 7-34-6A The undersigned applicant for this building permit does hereby certify that he under nds and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compile General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance froi all/co actors or s .- tractors empl yed by him in the work to be performed under this permit; and will post or cause to be posted fo in ion on the site of the work such bublic notice or notices as are required by the Act. The undersigned agrees to employ only such s b.I•..- actors, on work to ; :erforme &lpder this permit, as are licensed by Miami Shores Village. 7 — 4 Remarks • 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 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 2_7 c7 Date 3 Read, Sworn to and Subscribed before me. Disapproved (Signed) \ Building ector - My Commission Expires 4 to me well known, Notary Public, State of Florida 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.