660 NE 96 St (2)AFFUBCATODN FOR
Application is hereby made for the approl. al of th det, iled statenien• of the plans and specifk.t• ions herewith submitted fo, the build-
ing or o h, -ructure her f described This t-t heat:: is made in compliance and con o•m ty w•th the Building Ordinance of Mia ii
Shores Village, or da, and all pro isions of the Laws t f the State cf 1•1,rid. all o d nances of Mi of Shores Village and all rules and
regu a ion. of the Building Div - i of -tam Sho, illage t '1 e , o, ipled with, whether herein specified or not. A copy of approved
plans and specificat' •,• must be ket • at buudmg durin progress of tl.e wcrk.
r
i t � Date 1, �.5 �a
Owner' Name and Address.__ • �� AA__ 4? �� � '�- 1° r t t No
• Street_
Registered Architect and /or Engineer._ �_-
Name nd address of licensed contractor .l - )t
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
Disapproved _ ._ ... Date__
(Signed)
Ch
Building Inspector
MOAMO SH o RCS V LLLA E
BUILDIN INSPECTION DEPARTMEN
PLANNTrin , -. -
LJ
A f ^ 2
U LD11NG PE
1-�
r _ Subdivision
•
MDT
State work to be done and purpose of building (by floors)
,19
and for no other purpose.
New Building. . _ Remodeling__ ___ _ _ Addition__ _ _.__ .._ Repairs. . No. of Stories
To be constructed of _._ _ _ Kind of foundation Roof �ov 'ring
_ _
Estimated T. ,ta1 cost of improvements $ _ __� 3 C () Amount cf Permit $. r
Zone - •ubage required __. plan Cubage___ -.
Distance to next nearest building._ _Size of Building Lot
Maximuin 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 __ _ ___ _
The uncle signed appli ant for th 's bu1ding permit does hereby certify i'iat he understands and accepts his .•bligations :Wan employer
of 1 bor under he Florida Workmen's Co Act be•ng S- -tion 5966 Coi p led Gen al Laws of Florida P r anen S•ipplh num.
and h s compl ed w'th he prov - cons thereof, and will require s•milar comp lance from all contractors or subcontractors cmplo -ed by him
in the wo k to be p rl 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 c
or •otices as are requir d by the Act. The u. d. r ign -d agrees to employ only such ,ibcontr. etors, on work to be perform d der this
permit as are licensed by M am. Shores \ it : ge.
Remarks (Sig -fed) _ e FR 7 / /w
STATE OF FLORIDA,
COUNTY OF DADE. Ss. • � • ,: - - _ r ;�
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ..nd take acknowledgments, personally P p-
pcared
- - to me well known,
and who, being by me first d. ly sworn, upon oath depo-es and says that he is the .._ _
of th abov de 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 ie.
Pcrmit No Date__ ___ Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Commission Expires ______