1058 NE 98 St (15)Owner's Name and Address
Street and Number where work is to be done
and who, being by me first duly sworn, upon oath deposes
of the above described construction, that he has carefully
therein by him tate. »e�yd. Z's
Permit No // / Date -----
Disapproved __
(Signed)
( Signed) _
MIAMI SHORES VILLAGE
Bll i INSPECTION DEPAR?MENT
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.
Date_
Building Inspector My ommission Expires
/verC D ,19 bJ
Street_/_Y�._ 7._
Registered Architect and /or Effgine r.
Name and address of licensed contractor____ __ / t�`---X-e (J \.
Location and gal description of lot to be hilt on:
Lot__ / Block.___ O Subdivision_
/6 5P yE 9?
State work to be done an4 urpose of buildin by floors)__ -_ Alf,44
/lam f'.6�fA.ms.� /10 �laiGQ iC.P l t� V� .- -- - ° -- - __ _ v G r
/ and for no other purpose.
New Building Remodeling 6 Addition
. A cie:472,e40
Repairs
To be constructed of Kind of un Roof Covering
Estimated Total cost of improvements $ 7 • 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 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, 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 sub epptjacto ;s, o9 wor be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
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,
he is the
g application, and that he did sign the same, and that all facts
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
No. of Stories
PL 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 or changes to this application after approval has b obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper not we for ins inn or faulty
materials and /or workmanship.
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