823 NE 96 St (7)f
Location and legal description of lot to be built on:
Lot. I f;
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement En tne plans and specifications herewith submitted for the build.
in or other structure herein des This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and nil 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 ....... . ..... Street—lib:
Registered Architect and/or Engineer 21 WV, ••TIt•If ITIIITIMt•I •
Name and address of licensed contractor /1ji C ... ...
Block Subdivision. ' ( •
.•
Street and Number where work is to be LILL
State work to be done and purpose of building (by floors).... &P..-e-feteie-A -
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation oof Covering
Estimated Total cost of improvements $...P Amount of Permit
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
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 u ill) the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him
in the work to be performed tinder this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or noticcs as arc required by the Act. The undersigned agrees to employ only such suontracors, on work to ffiformed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
I
xint
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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
thcrcin by him stated are true. -
Permit Dat Read, Sworn to and Subscribed before me.
Building Inspector
Date
/
Notary Public, State of Florida
My Commission Expires ....
• • • • • • -••
to me well known,
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member —
Council Approved Date Disapproved Date
NOTE: A charge of 31.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re fee of 51.00 will be charged when such re-inspection is made necessary by improper notice for inspection oe faulty
materials anci/or workmanship.
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APPROACH
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Date
Approved
Correction
Re- Insp'n Fee
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MIAMI SHORES VILLAGE
2.4 "alp�
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Permit No.
Name
Address
Compan
Phone #
Inspection Date
4)&0,00