61 NE 96 St (7)MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN'
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det, iled statement of the plans and specifications herewith submitted for the build-
ing or o hr:: structure her •r, described This . t t 1ica is is made in compliance and con o-m ty w•th the Building Ordinance of Mia ii
Shores Village, t- .or da, and all pro isions of the Laws e f the State. of I krid. all o d nances „f Mi au Shores Village and all rules and
regu'a ions of the Building Div;: i :I of . lI :tin Sho,• illage 1 '1 a ^o, Ipl.ed with, whether herein specified or not. A copy of approved
plans and specifications must be ket ' at building durin, progress of the work.
Street_
Owner' Name and Address
Registered Architect and /or Engineer._.
Name •nd address of licensed contractor
Location and legal description of lot to be built on:
Lot -- --- - - - - -- -- - -- - - -- - - - - -- -- -- Block. - S bdivisio __ ^ o
Street and Number where work is to be done -
State work to be done and purpose of building (by floors)
To be constructed of -
Member --
Council Approved
New Building. -. _ - Remodeling.
(2! , µ ..
_ - Kind of foundation _______
Date
No
L
Addition.__ . __ ._ _ __. __ _ Repairs
Roof _
Estimated .tal cost of improvements $__ _720. C) Amount c` 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 speci:i.•ations for said building. All notices with reference to the building and its construction may
be sent to --- -
The unde signed appli ant for th ;s hu1ding permit does hereby certify t at he understands and accepts his .obligations as an employer
of 1 bor under he Florida Workmen's Compensation Act bang S. -t:on 5,..63. Col p led Ccn al Laws of Florida P r ante S• ppl, vent.
and h s compl ed w'th he prov' aons thereof, and will require •nuiar cola t: iari.e from all contractors or sub contractor cmplo •ed by liini
e
in the wo k to be p rf med under th s pern It and •ill post or cause to be posted for inspection on the site of the work su 11 public e s
or .otices as are requir d by the Act. The u do r ign •d agrees to employ only such :.ibcontr. ctors, on work to be perform
permit as are licensed by M am, Shores V � yr
Remarks.
(S g Ied) _
and for no other purpose.
No. of Stories
Notary Public State of Florida
My Com:nission Expires. _.. ......
,19
STATE OF FLORIDA, ss.
COUNTY OF DADE. J
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths .nd take acknowledgments, per :onall: ap-
peared
to me well known,
and who, being by me first d ly sworn, upon oath deposes and says that he is the -
ot th abov. de c. ibed . istruction t. , L has carefully read, the foregoing application, and that he did sign the same, and that ..Il facts
therein by him state e tr se. '
Permit No ____ -- -- - - - - Date..
,. k Read, Sworn to and Subscribed before me.
e_
Disapproved - -- - - -- - - -- - - - -- - -- - -- D €� _
y .
(Signed) - a ^ -
Building Irpector
PLANNING BOARD DATE
Chairman _-
Member
Member -_ - - Member
Member - - ----- .....
Date Disai.rro%. ed - Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application •ft.•r approval 1, s 1 • c n rht:rued from
the Plan' ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is me a. ncc•es,ary by improper notice h r insp' t.a, or it. ty
materials and /or workmanship.