901 NE 97 St (9)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 Shores Village and all rules and
regulations 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.
Owner's Name and Address
Registered Architect and /or Engineer ."1,1, <:K ...,: . _.
Name and address of licensed controctork.{
Location and legal description of lot to be built on: ! �� ' J% .
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors).��k4 �� 4'r1t,�.�l...L ^�
therein by him staye 'are ty
Permit No.._.___ Date
Disapproved
(Signed)
APPLICATION FOR BUILDING PERMIT
71t Date..
BuildJigE spe ctor
MIAMI SHORE S VILLAGE
19..
�/ ... No.�.l �� Street ,19..__
� �� e
PL
Chairman
Mcrhber
Member sass..
BUILDING INSPECTION DEPARTMENT
and for no other purpose.
Repairs ' No of Stories
Amount of Permit $.. 7 'c1. ".�� ttl•O
Addition
5 mo d_ .._sass
New Building Remodeling
To be constructed of ..� �' Kind of foundation 1�
Estimated Total cost of improvements $".C°.a • .--1
Zone cubage required .Plan Cubage
Distance to next nearest building ‘A(14.1,A.'±t Size of Building Lot
�fasunum 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 C tLc: i 3( . ®J — 6 t Ct t S o ��a 'CV y
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 su ntractors, on work to be performed under this
pennit, ts.tre licensed by Miami Shores Village.
Remarks._. \p.L. c9 , . �- ��. ° _ _ • (Signed
9 o pt-,) "—re,/
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
Member
Member
Member
Read, Sworn to and Subscribed before me.
NINC BOARD DATE
Roof Covering. f •
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
Notary Public, State of Florida
My Commission Expires
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 hoard.
A re inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection of faulty
materials and /or workmanship.