930 NE 96 St (8)MIAMI SHORES VILLAGE
Owner's Name and Address
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed state...ent uu we plans and specifications herewith submitted for the build
ing 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 progreu of the work.
Date.- ..--. 7
eo �c�e 11 , ffv4S
Registered Architect and /or Engineer r� 0'J
Name and address of licensed contractor 6 w ') e
Location and legal description of lot to be built 9n:
Lot.. 3 + 7- Illock — PP Subdivision / l / -
Street and Number where work is to be done.. 0 N £ .1 S
State work to be done and purpose of building (by floors)........L.
STATE OF FLORIDA, 1 .
COUNTY OF DADE. i ss.
Disapproved
(Signed)
Building Inspector
BUILDING INSPECTION DEPARTMENT
Date
r� ueJ ar>.to
. „, ,...,t,.....»,
•
_. _........... ...._... and for no other purpose.
New Building Remodeling Addition Repairi No. of Stories _
To be constructed of C.OA-Cnel Kind of foundation Roof Covering __
Estimated Total cost of improvements $ 0 Amount of Permit �. ... .2
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 a e plans and specifications for said building. All notices with reference tote building and its construction may
� -.e 6 o S of , i A.- :3 313 8..
�ufMJ 900 A./ .E- . . e l } v a4ue S� t
be sent to.. e . il'l
The undersigned applicant for this building perinit does hereby certify that he undcrsta and accepts his
of Ltbur under the Florida Workmen's Compensation Act, being Section 5966, Compil ' e ral Laws of Flor'
and has complied with the provisions thereof, and will require similar compliance frot ntractors or sub -
in the work to be performed under this permit; and will post or cause to be posted fo in .ection on the site •f
or notices as arc required by the Act. The undersigned agrees to employ only such su •, • - • actors, on wo
pennit, as are licensed by Miami Shores Village.
Remarks . — (Signed
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P3
o: gations as an employer
Pennap l t Sup pleutent,
employed by hint
rk such ublic notice
orme�ntider this
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..� � .,L .�� � Date 3 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commiuion Expires ........._ _ .__ _
PLANNING BOARD DATE
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 after approval has been obtained from
the Planning Board.
A re inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.
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