904 NE 96 St (7)7
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APPLICATION U LDING PERMIT
Application is hereby made for the approyai of the e,etai ec statzn of the plant's and specifications herewith submitted for the build-
ing or other structure herein described. This application is r '. in compi anc. and conformity with this Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of ` lo, ida, ail ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall ae cci iplied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progrea• c the wore.
Owner's Name and Address J a1 . C.s. _ Mc ( b
Registered Arch and /or Engineer.. _
Name and address of licensed contractor___
Location and legal description of lot to be built on:
Lo Block 7 - � ___ _ Subdivision . . V i I Vis S L C (r . ( ti
Street and Number where work is to be done _ - _ v_ ._ .- 9 6 ' r
State work to be one and purpose of building (by floors)__ _ Ck1 l n 1 a6k ! )
and for no other purpose.
New Building
•__ ...- . _.._ Remodeling.- _.__.. _... Addition._ . _ . - • Repairs -- _... .. _ _- ._. No. of Stories
To be constructed of Kind of foundation .__ Roof Covering
Estimated Total cost of improvements $_..__► Amount of Permit $.. C'=
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
/1 8 N Ave
be sent to_ ._ IkctA e c4c,
The undersigned applicant for this building permit dogs hereby cer ify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Sec 5966, Compiled General Laws of F :orida, Permanent Supplement,
and has complied with the provisions thereof, and will reeui:e similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post o 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 ::_nploy only e aeh strb tractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
L3.emarks__. -- _ -- --
STATE OF La LOR" DA,
COUNTY OF DADE. J ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take ack:aowledgments, personally ap-
peared
and who, bein3 by me first duly sworn, upon oath deposes and says tha` he is t h e
of the above described construction, that he has carefully read t'ie foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No _'_ _
Disapproved
(Signed)
‘ ) f�e s 2i
■eh nrai i an _
Member -
Member _
Council Approved._.
MIAMI S '" "% VILLAGE
BUILDING 5Na:: N DEPARTMENT
Date. _ Lief- C —_ _ ' J .. ___..__- :,lead, Sworn to and Subscribed before me.
- y e Date
r
Buildfog Inspector
PLANNING BOARD
Date... .. _ — , 19C?
c
No. _ % 0 _._ 6 ' 'r :A
Ee.Yk (le
-DATE
Member
Member
Member .
.Date Disapproved
to me well known,
Notary Public, State of Florida
iV'y Commission Expires
Date
NOTE: A charge of $1.00 will be made for making corer •ions or changes :o this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when s. -h ae is made necessary by improper not ce for inspection or faulty
materials and /or workmanship.
/L C'us:LE
At E. 96 ''J-
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76
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