1178 NE 99 St (14)MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statv...e•nr or me 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.../_... ...._ _.._ _ ...._._— ....._. ,19.1
Owners Name and Address ..P illS......l,el.. d4 _'e:c. — No. u StreetS1S _ -
Registered Architect and /or Engineer ..:.,• ••••...••••,.•:,,.,,n.,...•,• „-
/ l
Name and address of licensed contractor. 1P. 5etdr! .- .A�1L1.t!.1 ...... iQ •.._r)LQ. ».. .2c... aN c.•
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done .111B_ ns _ c ol St • _._ _ . __ _. _
State work to be done and purpose of building (by floors).. f.i i ..._ olio 1 1.l_.._4_ ...... _______
e w.1nc .U. u?.: •
and for no other purpose.
New Building Remodeling t — Addition Repairs No. of Stories _
To be constructed of Kind of foundation Roof Covering
cit. Total cost of improvements $...3 U D
. . Amount of Permit s7�Q
Zone cubage required .Plan Cubage .c
Distance .to next nearest building. Size of Building Lot a
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 un.lersigncd applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida NVorkmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the rovisions 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 arc required by the Act. The undersigned agrees to employ only such bcontractors, on work 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 authorized to administer oaths and take acknowledgments, personally ap-
peared rS R rnu0 � I�'_.
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 No. ._....2.a. S Date.... '.a ( .�
Disapproved \.... Date
(Signed) ..
Notary Public, State of Florida V
ivur;•K� ua:e. shit J+ , e.L)RJW. Al L LLA
My Commission Expirehtp. iss.mo roduSiltY
SCPC) 111W CieNEML t NS . dNL*ZWIII TE
PLANNING BOARD DATE
Chairman Member
Member
Building Inspector
BUILDING INSPECTION DEPARTMENT
Rea Sworn to and Subscribed before me.
Member
to me well known,
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 been obtained from
the Plannir,g Board.
A re- iuspection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.