873 NE 96 St (5)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
1
Application is hereby mode for the approval of the detailed statc,: ur me plans and specifications herewith submitted for the build
in 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 a the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the iuilding 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 ... p'fri e 5 .A G V
Registered Architect and /or Engineer e,:et nyme :ennettne +•e•nnun
Name and address of licensed contractor A ././ ..CQ. C.L? e % e
Location and legal description of lot to be built on:
Lot.. 2. — Z G Block ? `i' Subdivision . ` 11/...£.L/..SZf.I'' S'.___ • SC C_ 3
Street and Number where work is to be done '' .l✓ _ . Zr- C'S f _...
State work to be done and purpose of building (by floors) .C.Q..GflC.I. .C_zie lti f Vc°. #1
Ne Building Remodeling Addition Repairs No. of Stories _
To be constructed of Kind of foundation ) . Roof Foverin
Estimate Total cost of improvements $ > . G'.r'1'..D 3
Amount of Permit ./�) i.fr it
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 en
of Labor under the Florida Workmen's Compensation Act, being Section 50G6, 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 hint
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 ppulplic notice
or notices as are required by the Act. The undersigned agrees to employ only such sum .ntract• s, o:a work to be forme under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
E/o
Building Inspector
and for no other purpose.
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorizcd 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
therein by him stated are true.
7
Permit No. .__rv Date. ..il . r ...
Disapproved — kt Date
(Signed) '\►" V.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
to me well known,
Chairman Member
Member 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 airier approval has been obtained from
the Plannir., Board.
A re-inspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
76
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