801 NE 96 St (6)EA C SHD V LLA9E
UIi-DING INSPEC T ON DEPARTMENT
;a:, L L CAT / ®N F0 EIU LD NG PERMIT
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 he :cin 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.
So
Owner's Name and Address
aegistcred Architect and /or Engineer _ f �
Name and address of licensed contract 'r 47//
Location n le al description of lot to be built on •
Block
Lot
Street and Numb. r where work is to be done
State wo to be e rpose of u' nip( floors
New Building... -_ '' Remodeling A. dition
To be constructed of Kind of oundation
Estimated Total cost of improvements $ er69-
Zone cubage required
Distance to next nearest building
Chairman
Member
Member ....
ate
Building Inspector
Subdivision
Amount of Permit $.
.Plan Cubage
Size of Building Lot
. A/eire- 47
f /fr,/ /'' pp e - ,19
�Streecll� I.��
Read, Sworn to and Subscribed before me.
!'d 4:4 16 3 3/ 6 (
LA&crie o
A ...
and for no other purpose.
pair No. of St
Roof Cove iAg
Maximum live load to be borne by each floor
I hereby sul3mit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to....
•
The unders -geed applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under t..; 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 s•ib- 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
y
or notices as are required by the Act. The undersigned agrees to employ only such subcontra, on work be o5d under his
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLCMDA,
COUNTY OF DADE. y ss.
3efcre me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
— - - 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.
Permit No ) 3 (4 / Date.-7—
Disapproved
(Signed)
Notary Public, State of Florida
My Commission Expires
PLANNINk'' BOARD DATE
Member
Member
Member
Council Approved Date Disapproved Date
NOTE: A el,,,rge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
tl,e Planning Bc,ank.
A re- inspcci.on fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.