801 NE 97 St (11)Application is hereby made for the approv al of the (let, iled statemen• of the plans anfl specifies ions herewith submitted for the build-
ing or o h, -ructure her r described This r'ilicatic is made in compliance and cowry ty w.th the Building Ordinance of Mia ri
Shores Villave, or da, and all pro isions of the Laws c the State of Fkrid. all o d nances of Mi nr Shores Village- and all rules and
regu'a•ion of the Building Div.. i of •lam Sho. illage 1' 'I e ro, ipl.ed with, whether herein specified or not. A copy of approved
.Mans and specrficati .nv must be kei at building durin progress of tl.e wcrk.
I
Date
t /—
} _
Owner' Name and Address 19 jtw��� No
Street_. __
Registered Architect and /or Engineer.
Name nd address of licensed contractor_ -
Location and legal description of lot to be built on:
Lot - rA .. _ Block.__ ___. 1 3 _. Subdivision
Street and Number where work is to be done °'_ ' '
State work to be done and purpose of building (by floors)
New Building_
To be constructed of
Estimated ;tal cost of improvements $__ /1 Amount cf Permit $__ .
Zone 'ubage required_ __ __Plan Cubage
Distance to next nearest building__ _ _ _ Size of Building Lot
Maximum live load to be borne by each floor _ . _____
hereby submit all the plans and speciiieations for said building. All notices with reference to the building and its construction may
be sent to
The unde signed appli ant for th binding permit does hereby certify riat he understands and accepts his obligations as an employer
of I bor under he Florida Workmen's Compensation Act being S• -tion 5966 Coi p led Gen al Laws of Florida P r anen Sipple rent,
and h s compl ed w:th he prov• ions thereof, and will require s•milar comp lance from all contractors or subcontractors emplo .ed by him
in the wo k to be p ri -med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public noti e
or .otices as are requir d by the Act. The u. d.r ign. -d agrees to employ only such abcopkh tgr on wort to be pprforn. d der this
permit as are licensed by M am. Shores N. it : ge. ! f 1
Remarks (Signed) 1 '
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally Pp-
peared
Permit No ._ Date_
Disapproved Date
( Signed)
Council Approved
Building Inspector
SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
APPLICATION FK :i F= .LUILDING PE MIT
PLANNING BOARD i — e 3 - S
Chairman s,� % ' Member
Member � �, , �: � � �
: �= , Member
Member - ° A " _ __ `, . ..?' Member
_Date Disapproved
and for no other purpose.
Remodeling._ ____ _ ._. Addition____ ____ ___ _____ __ _ Repairs. _ _ _ No. of Stories
_ Kind of foundation Roof Cov gyring__ -
and who, being by me first d. ly cworn, upon oath depores and says that he is the
of th abov de •c ibed • istruction t. • h has careially read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr re.
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nission Expires_
DATE
,
.to me well known,
tq
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application tft -r approval h is hecn obtained from
the Planr ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is mr le necessary by improper notice fur inspe :•t•or or fa• tlty
materials and /or workmanship.