889 NE 97 StMIAMI 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.
1
Owner's Name and Address .....4t.drad
Registered Architect and /or Engineer
Name and address of licensed contract
Location and legal description of lot to be built on:
Block 7 _ -__ Subdivision •}
Street and Number where work is to be done S2
State work to be done and purpose of building (by floors)
New Building
Remodeling_____ __________ Addition
To be constructed Kind of foundation
Estimated Total cost of improvements $ "J . 427 _—Amountof Permit $ 1__4
Zone cubage required O p O 0 Plan Cubage Z / . f r�
Distance to next nearest building . Size of Building Lot sg• i'7 h //2.
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.
Remarks (Signed
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved
Date
(Signed) , e
Building nspector
Member
Council Approved
NNING
Chairman/ �� — - – — Mem. r
Member Member
Date__
— Street .S�� o
_ DATE
_and for no other purpose.
Repairs __ No. of stories__
_ Covering_
Before me, undersigned ut nty, a otary ublic, duly authorized to administer oaths and take acknowledgments, personally
appeared
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 carefull read the foregoing application, and that he did sign the same, and that all facts
therein by him s are true. r ..,
Permit No._ a Date / / __ Rea., worn to i ,d Su t ibe4)efore me.
Notary Public✓State f Fl
No ary 1"1 l ic, ta1 3 0t Htlt at La rq u .
y Co. mission Expires My commission t . :pi... t'.�.' "s Y• _.i4fl_
itrs►Pdb_d_by American Surety Co. of N. Y.
Member
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.