1178 NE 99 St (2)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 oiler structure heron, described This . t-plicatic:: is made in compliance and conrorm,ty with the Building Ordinance of Miami
Shores Village, Florda, and all pro\ isions of the Laws i f the Statt, of l lcrida all o finances of Mi .nu Shores Village and all rules and
regulations of the Building Div; :i, n of '.liana Shop illage 1 '1 ,e ro iplied with, whether herein specified or not. A copy of approved
plans and specifications must be key at building durin progress of the work:
Owner's Name and Address
New Building
To be constructed of
Permit No._ _
Disapproved _. ______
(Signed)
Chairman
Member
Member _ _.
Council Approved
MIAMI SHORES VILLAGE
BUILDING, INSPECTION DEPARTMENT
_�. Psi M
Remodeling
Registered Architect and /or Engineer _
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block ..'_? 7
Street and Number where work is to be done.
o
Q1.,
Subdivision_ 12.
7 l N e __.`__;ST
State work toe done and purpose of building thy floors)
Date_.
ector
7
PLANNING BOARD
Addition
S Kind of foundation
Estimated " ,tal cost of improvements $__1_ fl Amount cf Permit $._
Zone ^ubage required __. .Plan . Cubage 5
Distance to next nearest building_. _ . Size of Building Lot
Maximum live load to be borne by each floor
hereby submit all the plans and spe ciii,.ations for said building. All notices with reference to the building and its construction may
be sent to -
The uncle, signed appli ant for this budding permit does hereby certify That he understands and accepts his Obligations as an employer
of 1: bor under he Florida Workmen's Compensation Act bc'ng S •tion 5 66. Cor piled Gem -al Laws of Florida. P-r. ,anon. Supph rent,
and h s compl-ed w'th :he ploy - :ions thereof, and will require similar corm lance from all contractors or subcontractors emplo•-ed by him
in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of th work such �) , iblie noti� e
q r s' 7 - P IQ ' this
Date
or otiees as are re uir d I y the Act. The u, d, r igri. d agrees to employ only sue
permit as are licensed by M am, Shores \
Remarks (Sived) _
Member
Member
Member
Disapproved
Date
No Street_
Repairs .
7-
and for no other purpose.
No. of Stories �
Roof Covering
tr ctop, q[i..werx_ ko
1 74. 11
3u /V&A/ € .1T
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ..nd take acknowledgments, personally ap-
peared
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nission E x p i r e s
_DATE
to me well known,
and who, being by me first d. cworn, upon oath depo'es and says that he is the
of th abov. de .c ibed ■struction t, : 1, has careislly read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are to e.
Date
NOTE: A charge of $1.00 will be made for making corrections or ?Flanges to this application .ft-.•r approval h s lei 11 rbtamed from
the Plain' ng Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is m.:.' nteessar} by improper notice fix inve.t'cm or Le ity
materials and /or workmanship.