833 NE 96 St (2).....__...._..__ .and for no other purpose.
• New Building Remodeling Addition Repair ` No. of Stories / _
To be constructed of Kind of foundation Roof Covering /-" T. e / '- ./."''. /IA
Estimate Total cost of improvements $ i 7SC Amount of Permit L /S re- ,;:e--
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.nnd specifications for said building. All notices with reference to the building and its construction may
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for tl►c approyal of the detailed statc,sle•ne sae ine plans and specifications herewith submitted for the build
ine 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.
- y Date..._..._... _...�...._......_._`... rs 7/ � _.... 19 ee _
Owner's Name and Address .....1..1 pie? ,, !/ �. . ....__ _ No....- .....:3........ Street--M 6 ;_ ?i
Registered Architect and /or Engineer , •f,•••,,.• 1„HM44gMf•
Name and address of licensed contractor CO i '�? - f ' - / ,'
Location and legal description of lot to be built on:
Lot Block Subdivision ... ___....._......__
Street and Number where work is to be done
r
State work to be done and purpose of building (by floors) _../�E'‹'� °_�' f /- y_3 l 'i - / -
_ .........__.... _ ...._. _.._.._�
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 S►lpI►leu►ent,
and has complied ith 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. y
Remarks ._ (Signed)-.—
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
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. ( .1_
Disapproved Date.
(Signed)
Date ' ( Q._._._ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector ` My Commiuion Expires
PLANNING BOARD _.._......DATE
Chairman — Member
Nferr,ber — Member
Member .. .. _....._..._._...._....._ Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Plannir.g Board.
A re•iu.pe•c•tion fce of SI.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
n►atcrials anti /or workmanship.
Qualifier
OWNER'S AFFID
be done in ••m
autho
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address e'5,3 - 2' 9CS/ Tax Folio //$, /1 A a0
Legal DescriptioncV9 / ! /W,.§r /)
Owner / Lessee / Tenant F ✓ 2 i4 Master Permit
Owner's Address 7 i ' Phone 7f7 of'd
Contracting Co. s 4a __ Address
, € - Phone f t ao
State # Municipal #-5/Y5 Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost(value) - c'-" -c)' '
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
VIT: I certify that all the foregoing information is accurate and that all work will
liance w'th all applicable laws regulating construction and zoning. Furthermore, I
ontra or to do the work stat
er- Builder
dr Na OC197515
r
Signature of
Date: z%l ge/
N
** *
APPROVED:
ary as to Owner and/
M A Commission Expires:
Zoning
tar as to Cont
y Commission Exp
Mechanical Plumbing
Contractor or
FEES: PERMIT 47,3 RADON C.C.F. `J ') NOTARY ✓ ° 0 0
Fire
Buildin
*
**
TOTAL DUE ` ' Q�
Other
Electrical
Engineering