1043 NE 98 St (11)BUILDING
ELECTRICAL ❑
PLUMBING ❑
ROOEI Di
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Owner of
Building
Architect
CO
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rss
eith r, mys
Contractor
or Builder_
Legal
Description
Address of
Building
'Tlds permi
herefor 'in strict comp an
drawings, statements or speed'
time if the work is not done in
granted is the understanding
pertaining to the work ove
done by his agents, servants or
In consideration of the issuance to
raining thereto and in strict torkformity
n accepting this permit I assume respo
CTOR OR BUILDER
BUILDING INSPECTION DEPARTMENT
MIAMI SHORES VILLAGE g�
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 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.
1 0
/ �� Date 1 /
Owner's Name and Address.. i:..t.Z ) �� "41. : �... �_. No Street
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built n:
Lot ... Block ... - -I. Subdivision.
Street and Number where work is to be done..[ °
State work to be done and purpose of building (by floors).
New Building 1------ Remodeling. Addition
To be constructed of.- - Kind of foundation
Estimated Total cost of improvements $ — ap t L9 Q - 0 A
Zone cubage required r _ -t✓'
Distance to next nearest building. ,R d I" -4—
Date
Date
PLA
Chairman
Member
Member
Council Approved
Date
NOTE: A charge of $1.00 will be made for making
the Planning Board.
A re- inspection fee of 81.00 will be charged
materials and /or workmanship.
and for no other purpose.
No. ofl rte ;,
Roof Covering
uu //
mount of Permit ; ....'/ i!?
_Plan Cubage ,e A.,/. YR. lk
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Size of Building Lot U o 'rf o3.
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 employer
of labor under the Florida Workmen's Compensation Act, being Section 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 a work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on q, performed under this
permit, as are licensed by Miami Shores Village.
Remarks
(Signed).
STATE OF FLORIDA, I
COUNTY OF DADE. j 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 statrue.
Permit No
Disapproved
(Signed) L
Building Inspector
Read, Sworn to and Subscribed before me.
ING BOARD DATE
corrections or changes to this application after approval
Member
Member
Member
Disapproved
Notary Public, State of Florida
My Commission Expires
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
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J. B. FORD CO.
1774 W.: Flagler Street
MIAMI 33, FLORIDA '
Phones'; FR 9 -3508, FR 1 -0027
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ORDER NO, 2 -15% 3
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I HEREBY CERTIFY that, the attached sketch represents
a syrvey made under my, direction and is the and correct
There are no encroac ts except as shown.
REGISTERED T , s i ' • OR 1128
S OF FLORIDA
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According to the Plat thereof as recorded in Plat Book 6 7 , at Page
Public Records of Dade County, Florida.
Fore ,,l Y CLfiU55E1 11 Date E3 /5 to
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