1097 NE 98 St (12)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Applicat on is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing o_ other stru ture he ein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores V:llag -, F orida, and all provisions of the Laws of the State of Florida, all ord of Miami Shores Village and all rules and
regulations of the Building Division of Miam Shores Village sh II be con plied with whether her in specified cr not. A cop of approv d
plans and specifications must be kept at bu.ldmg during progress of the work.
Owner s Name and Address
Registered Architect and /or Engineer __ _
Name and address of licensed contractor _ __. _
Location -nd legal description of I_-t to be built on:
Lot__ __ _ _ _ Block
Street and Number where work is to be done_
State work to be done and purpose of building
New Building
To be constructed of
Remarks__ _.
r
STATE OF FLORIDA,
COUNTY OF DADE. j
Chairman .
Member
Member _ _ -
Cour ail Approved
NOTE: A charge
the Planning Board
A re -in_ eL.I c.s fec of $1
materials and /or workmanship.
i fLut:3-
MIAMI SHORES VILLAGE
Remodeling
Subdivision_
by floors
Addition.
_ _ Kind of foundation
Estimated Total cost of improvements $ ___ _ _ '� _ _ - _. _ _Amount of Permit $ _. ilp
Zone cubage r e q u i r e d- - - - - - - - - - - - - - - - -' - - - _ _ _Plan Cubage _ _ __ _ _
Distance to next nearest building_ . _ __ . __ _ . ` —_ __ _ _Size of Building Lot____ _
be sent to _ ___
(Si
and who, being by ma first duly sworn, upon oath deposes and says that he is the _
of Ihe above described construction thai he has carefully read the foregoing a:,plicat■on,
therein by him stated are true.
Per : it No. _ _ f 0 4 ( _ Date_ _ 1 - Read, Sworn to
Disapproved _ . _ -
( Signed)
Building Inspector
PLANNING BOARD
Da,e
Member .
Member _
Mc
ber
D sapproved
Date_ _ ` ✓
__. No. __I-e 7 -- Street__ WE
and for no other purpose.
_ . Repairs__ __' " ._ _ No. of Stories __
Roof Covering --
Maximum live load to be bcrne by each fl o o r- - - - - - - - - - - - - -- _ _ _ - - _ _ _ _
I hereby submit all the plans ar.d specifications for said building. All notices with reference to the building and its construction may
The undersigned applicant for this building permit does hereby certify that h- 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 pr'w sions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed u der 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 agree:: to en ploy only such subcontractors, on work to be pe formed under this
permit, as are licensed by Miar. Sho es Village. `� n
Before me, the undersigned authority, a notary pubh.:, duly uthorized to administer oaths and take acknowledgments, personally ap-
peared - - - - - - -
a n d that he did sign the same, and that all facts
and Subscribed before me.
-
Notary Public, State of Florida
Commisson Expires _ _ _
DATE
7 d
19 .
_ __ to me well known,
_ _ Date
of $1 00 will be made for making corrections or changes to this appl cation after approval has been obtained from
.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
MIA I SHORES VILLAGE, FLA. No 5878
JOB ' .6s)
ADDRESS /n 9/ A ?Iv th S
INSPECTION
TIME READY c3/' 7
REMARKS
r
.t
INSPECTOR
DATE
BUILDING
ELECT/I/CAL
PLUMBING
ROOFIN
tion
at
pee
regelati
sibitity far
•
Signed:
perform he 'at rk coy
erc;enta or ne
myeeL ag aer
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
l
0
0
MIAMI SHORES VILLAG E FLORIDA
DATE. 1 - a -I.
Contractor's
License No.
In ensstdeted eI the Maumee to me of
p@rtaining dumb and Is Wet confortsky vin et the p cue,
cowing this t I =name lesponsikally for etil work done
PERMIT N9 7041
Work to be performed under this Permit____
Value of II Amount of J •� _
Project $ 00 I Permit $
e to construct the building or to install the equipment or device described In the applica-
and with uaderstaadiag that the work wal be performed is compliance with any
w itted to and approved by the proper municipal authorities. This Peru may be meted
or if the plane are : aaged without autherk iea. ecantition spec 'nhds this
' 'named above assumes the read ter a those >+ne e' of the. Ordinances and
he plans or drawings or in the or lae ciffoadons and that assumes respers-
KU1103111TY near efielo
Owner
Building
Contra cd;„,
or Builder 6k 4
Legal Lot
Description
Address of
Building
Lion he
plaasy
at any time* .
pe
iese
fay
pertaininsthanto
cepting Zia
0
14 CA 1
O
a
or e • the t ies-
i s • ee wt a ny
€ e6
ort
w:� bad
al, *rid
a of
BUILDING SHORES VILLAGE, FLORIDA
ELECTRICAL
PLUMBING 0
ROO 0
Architect
Wa to be performed under this Pennst °` ► Ax
BY
0414 ebv. to
batter aathed wive ttr coasts
permsg 'moo and with
may have hue *raised tb aad approved D_
ith web ordittatats or if the plena are ehange
r or balidea mated above memos the reap
Alma ea the plaes or drams is the stave
DATE. it.)
Contractor's
License No.,