1178 NE 98 St (10)/-5
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Application is hereby umdc for the approval of the detailed statc,,,cnr ui ine 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.
State work to be done and purpose of building (by,floors
BUILDING INSPECTION DEPARTMENT
Owner's Name and Address
Registered Architect and /or r..incer
Name and address of licensed contactor
Location and le al description of lot to be built on:
Lot 7' Block /.GFt Subdivision. .. .C/. /..
Street and Number where work is to be done //-21
Date
D a t e . - 18
id,6412.
a
rt,. •t, •••n,•• tna<rwt••nt MIL ',It.
&fee g 4 4/Cl
and for no other purpose.
New Building ... Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundatio Roof Covering
Estimated Total cost of improvements $ ,a `••• Amount of Permit $ ZQ (D
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 Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Snp ilrurent,
and has complied .eith 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 t / he of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, o to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) -
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorizcd to administer oaths and take acknowledgments, personally ap-
peared
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 carjefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated a true
Permit No..
Disapproved .. _ ..... . Date
(Signed)U"
Building Inspector My Commission Expires
PLANNING BOARD DATE
Ciiair.nan Member
Mfcrr,ber 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 hero obtained from
the I'Linnir,. board.
A
a.- inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
6M-o cs
to me well known,