790 NE 97 StMIAMI 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 b•tilding
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 regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approvei plans
and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engine-1r
Name and address of licenced contractor
Location and legal description of lot to be built on:
Lot__ Block__ Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
To be constructed of__—_ Kind of foundation
Estimated Total cost of improvements _________— ,Amount of Permit $
Permit No Date
Disapproved __ _____________ Date
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
Date_ , _ __.._ - , 19
No _______ _________ Street__.— _____— ________.
___ __________ _________ —___and for no other purpose.
New Building Remodeling__________________ Addition______________ . , Repairs No. of Stories_______________
"Roof Covering__
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 constructior, may
be sent to
The undersigned applicant for this building permit does hereby certify that be 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 sgbcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well kt.own,
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.
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.
Y Date � A �� , 19—
�
Owner's Name and Address 1 Y !G ('`" ', L , t, c ` ' No Street
Registered Architect and /or Engineer ( T ;LV
f,, ; , ( rt
Name and address of licensed contractor___. at -4 -- - -.
Location and legal description of lot to be built on:
Lot i t Block �� Subdivision t `' _�__;_ s
Street and Number where work is to be done __ C___ ------- (-
_�_'a____ -,, % <_
State work to be done and purpose of building (by floors)___ � L I_A` „__i` " -. °/
New Building (� Remodeling Addition__ ` Repairs No. of Stories
To be constructed of `- ' Kind of foundation P >°,,,,, ‘C-;,.-'. ‘" ` , „' ' Roof Covering
Estimated Total cost of improvements $ `t > n ;-, Amount of Permit e $ ',
Zone cubage required _Plan Cubage L 4
Distance to next nearest building t _____ ___':______________________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 construction may
be sent to
The undersigned 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 ( Sign
x_ r
and for no other purpose.
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personalty 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.
u
Permit No. t?'_'__ ; ` Date %��__�'___ Read, Sworn to and Subscribed before me.
Disapproved _, Date Notary Public, State of Florida
(Signed) -- – _ _ r –° --
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member _ Member
Member Member
Date Disapproved Date
or changes to this application after approval has been nbrai »era from
'mnroper notice for inspection or faulty