95 NE 96 St (2)Owner's Name and Address E R- T
Name and address of licensed contractor
Location and egall of lot to be built on:
Lot - - of 22- Block 10
Date
Disapproved �� f Date t
( Signed)'°` d_ __ . ..
Building Inspector
VILLAGE
BUILDING INSPECTION) DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval 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 :,nd
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.
Street and Number where work is to be done _
State work to be done ann purpose of building (by floors). (_ _ _s. , e LQSC
W tN)a._t A) W 5(1.)i gLfits j)CO2
e f �1 ri a r../
New Building Remodeling X Addition
5 _ 4 . 114 s-)
Date - ba.1 lV E 1 0
Subdivision M IAMi 2e3
No 9 Street_._
Registered Architect and /or Engineer
e F
Read, Sworn to and Subscribed before me.
Repairs No. of Stories
,194
(Z.
efisr st2 e, ws 0/7
and for no other purpose.
To be constructed of Kind of foundation - Roo,9gvering
Estimated Total cost of improvements $ I *b 0 Amount of Permit $
Zone cubage required .Plan Cubage 210. I1 •
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 sentto
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 5968, 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 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 performed under this
A n
permit, as are licensed by Miami Shores Village.
Remarks- ----- -- -- ---------- - -- - -- --- --•-- ... (Signe
STATE OF FLORIDA,
COUNTY OF DADE. 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 i
Notary Public, State of Florida
My Commission Expires
PL 1) ING 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
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.
or changes to this application after approval has been obtained from
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