760 NE 96 St (4)Date ;71_3/er 19
Owner's Name and Address No. 7 St trec T 6 $ T
MIAMI 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 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.
Registered Architect and/or Engineer
Name and address of licensed contractor
pfl&) A- A. it2
Location and legal description of lot to be built on:
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Lot I ./ f S S Block L'K •• ' � Subdivision i/} h `/ IL �
Street and Number where work is to be done / 6 ° Alf- (O 7 5 -7
State work to be done and purpose of building by floors /, state exter r colors (submit samples) �
9 (c �� 6 (0 =S� LJ)) � �c S
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and for no other purpose.
New Building Remodeling Addition Repairs No of Stories
To be constructed of Kind of foundation . r'� Roof
f s
Covering
Estimated Total cost of improvements S /M
`Z—' / � OO• Amount of Permit "�'t�'" — �le o
_
Zone cubage required Plan Cubage
Distance to next nearest building ri Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all 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 obligatons as
Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has co • .lied wi t
compliance from all contractors or sub - contractors employed by him in the work to be performed under thi /ermit;
on the site of the work such public notice or notices as are required by the Act. The undersigned agre. employ
under this permit, as are�nsed by Miami Shores Village.
Alf
/7,2-7
Remarks 5 5 ' C C a co S/' // p�
(Signed)
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me. the undersigned authority, a notary public, duly authorized to administer
0/11 0/11 r i/9
an ploy
the pr is
d will ..st
y suc su .
the and take acknowledgm•nts, personally appeared
(fB8,G -Sw L7
of Labor under the Florida Workmen'.
s thereof. and will require similar
cause to be posted for inspection
ontractors, on work to be performed
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 therein by him stated are true.
e fiX , 6
Permit No. 704
Disapproved
Date
Date
(Signed)
Building Inspector
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
Notary Public. State of Florida
My Commission Expires
Chairman Member
Member Member
Member Member -
Council Approved Date Disapproved _ Date
NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and or workmanship.