938 NE 96 St (8)MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of the 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 progress of the work.
Owner's Name and Address... /. '
Registered Architect and /or Engineer... _ . . . .
Name and address of licensed contractor_ .... _ .
Location and legal description of lot to be built on:
•',
. L ! 31 :.�a e °.
/" '
Lot. R� *� Block 6.__ _ Subdivision
Street and Number where work is to be done 9.Ye
State work to be done and purpose of building (by floors)__ - _. • `
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 $
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 foi said building. All notices with reference to the building and its construction may
:se s::,t
to C�,+�= -7vE/2s1e- Co 7185 N. L✓
The undersigned applicant for this building permit dot hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act. being Sec:ion 5966, Compiled General Laws of Florida, Pennanent Supplement,
and has complied with 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 p ublic notice
or notices as a re required by the Act. The undersigned agrees to employ only such sn tractors, on work to be performed under this
pa. _t, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me,
peared
Disapproved
(Signed) _
Member .
Council Approved
Dat
ilding Inspecg6r
BUILDING INSPECTION DEPARTMENT
( Signed )
Member
_Date Disapproved
Date ,
No Street
• .. ._. •..air :;
undersigned authority, a notary public, duly authorized to administer oaths and take a, `nowledgments, personally ap-
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 6. _
Date 7-C -- Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires__ __
ANNING BOARD__ __ . DATE
Chairman __ _ Member
Member __.__ _ _ -_ Member
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 fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
E 96 "cf;-