839 NE 97 StOwner's Name and Address
STATE OF FLORIDA,
COUNTY OF DADE.
se.
Disapproved
(Signed) _—
Council Approved
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 building
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 approved plans
and specifications must be kept at building during progress of the work.
Registered Architect and /or Engineer ,,nn //
Name and address of licensed contractor _--0
Location and legal description of lot to be built on:
i
Lot_ i _ 7 ' I UJ /1_12_ Block 7 Subdivision
Street and Number where work is to be done P;� �� -
State work to be done and purpose of building (by floors) ' '" `n �" ' ' `
r
------------- __ —_ - -- 1 t ? ° _ and for no other purpose.
New Building —__ Remodeling_______________ Addition__________________ Repairs No. of Stories___1 —_____
To be constructed of __ —____ Kind of foundation — _____ ___ _— ' Roof Covering_ —
f1 c cs -} , ,!- f •
Estimated Total cost of improvements $ _ , __ —_ —_ A ount 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 construction 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 subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. c,
Remarks (Signed) _— •`_i °Z ••`
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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.___11� ____ —___ Date
Date_ —� ? 19
/ C v
Street... Z
Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member _____,___ Member
Notary Public, State of Florida
to me well known,
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.
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 ,Sh res Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specif d not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address Q1044 , v_
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal des ;iptio of lot to be built on:
Lot L /GG l/Block 7j Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building .;
MIAMI SH u RES VILLAGE
C OZ
No. � Street
19 �
and for no other purpose.
New Building Remodeling Addi ' Repairs No. of Stories /
f
To be constructed of Kind of oundn Ov:, .,._4...,, Covering �
Amountfof Permit $
Ylan C:ubage;
Size of Building I38t '
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 applicant for this building permit does hereby certify that -h t 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 complian from all contractors or sub - contractors employed by him
in thv work to be performed under this permit; and will pos or cause to be post 11 for inspection on -he site- ofathe work such public notice
or notices as are required by the Act. The undersigned agrees' to employ only suc subcontra ors /' wgfk to be✓perfonned under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) �.-%A . -_._,!
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
- - - -- 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.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
( Signed)
Building Inspector My Commission Expires
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.
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