870 NE 97 StPermit No
Disapproved _
( Signed )
Member
Council Approved
MIA 8 SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
APPLICA1'8 N FOR UILDING PERMIT
Application is hereby made for the approval of the (let, iled statenien• of the plans and specifications herewith submitted for the build-
ing or o h, -ructure her r described This t t•licatic is made in compliance and con•o'm.ty w,th the Building Ordinance of Mia i
Shores Village, i .or da, and all pro, isions of the Laws cf the State of I•h,rid. all o d nances of Mi 1u Shores Village and all rules and
regu'airon. of the Building Div.. i of .lam Sho. illage 1- '1 ,e ro, ipl.ed with, whether herein specified or not. A copy of approved
plans and specificati .ns must be ken • at building durin progress of tl.e wcrk.
Owner' Name and Address___._ __Thomas L. Jackson N 9822 Street_. N.E.2nd Ave.
Registered Architect and /or Engineer__. Harry E.Penney
Name .nd address of licensed contractor. Y_-. r 1
Location and leg al description of lot to be built on: Lot 6 & East 2 of Lot
Lot_ __ ___ (a° 7 Block._? _. Subdivision Miami Shores Section 3
Street and Number where work is to be done_ B7Q_ N.E.9_7th___B_tr_eet.
State work to be done and purpose of building (by floors)
One Family 6BS Residence
ate__
nspector
PLANNING BOARD DATE
Chairman Member
Member ____ Member
Member
_Date Disapproved
Date Nov. , , 19
1 its"
and for no other purpose.
New Building_ X _ _ Rernodelin Addition____ ____ ___ _____ __ _ Repairs. _ _ _ No. of Stories. ]'.
To be constructed of_ CB$ K f o d C OnC r e t e of C y gyring__ Tile
Estimated ' •tal cost of improvements $__ _ Amount of Permit $_
Zone nubage required_ __. 20 y OOO cu o ft o _Plan Cubage
Read, Sworn to and Subscribed before me.
Distance to next nearest building_ _ 2O feet _ _Size of Building Lot 7 5 _. x f t.
Maximum live load to be borne by each floor_ _ _ _____ ___ ___
hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to Thomas_ L, Jackson_ care. of Miami Shores Bldrs..Inc, 9822 N.E.2nd Ave.
The unde signed appli ant for th's budding permit does hereby certify t'iat he understands and accepts his . bligations as an employer
of I hor under he Florida Workmen's Compensation Act being S •tion 5966 Coi p led Gen al Laws of Florida P r anon. Sipple Went,
and h .s compt ed w ;th he prov•:ions thereof, and will require s•milar compliance from all contractors or sub - contractors emplo •ed by him
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 :h public: note e
or , .otices as are requir d by the Act. The u. d•. r ign.•d agrees to employ only such abcontr. ctors, on worly,,t g - perform . der this
permit as are licensed by M am, Shores ill: ge.
Remarks__ _ _ .. (Sig
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,..nd take acknowledgments, personally 'p-
peared _. __. __
.to me well known,
and who, being by me first d. ly sworn, upon oath deposes and says that he is the
of tli abov. de.cribed . istructign i h has careially readfff ie foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie
Notary Public State of Florida
My Com:nission Expires_ ____ ______ ___ __________
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application tft,•r approval h.is been obtained from
the Planr ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is ma.ie necessary by improper notice for inspe :•t'or or fa. ity