1183 NE 99 St (8)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby snack for the approval of the detailed statement ut ore 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.
Owner's Name and Address r t - �"l —
Registered Architect and/or Engineer � r n , ^+ � _
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot . Block Subdivision
Street and Number where work is to be done LL ...... E r cl
State work to be done and purpose of building (by floors)..... Le �
LL.NAC? Otid -) ta.)
)
50 4.020
New Building Remodeling Addition
To be constructed of Kind of foundation
Estimate Total cost of improvements $ Q? , 00 0
Zone cubage required
Distance to next nearest building.
and who, being by me first duly sworn, upon oath deposes and says that he
of the above described construction, that he has carefully read the foregoing
therein by him stated are true.
Permit No %/ 11.6 / Date I4 f
Disapproved ... ...., , Date
(Signed)
Building Inspector
Chairman
Member ,.
Member
Date tria ! a ,19.54!
_ No. ... 33 ._... street M Q E ..(9
\iaxiunum 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 Honda Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has crnnphed with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in tl :c 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 j bcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLOFIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared 3>i'h'... tr
PLANNING BOARD
Rea
My
is the.
11 . t•t....,...,,..,.....,....,t'J ltt,,2lt
and for no other purpose.
Repairs No. of Stories
}} Roof Covering
Amount of Permit 5 1. .... !1 _
plan Cubage
Size of Building Lot
application, and that he did sign the same, j.nd that all facts
d,
•
not* fithsi c vtaf r UOA
Rt-- ALIAILIt.._..._...
COOMAISi1a E7Pt 25 1983
C°"1011410)1pemeattavit INS, UNDERWIUTPS _...
rn to and Subscribed before me.
................ _.._...... DATE
to me well known,
Member
Member
Member
Council Approved Date Disapproved .. , _ Date
for making corrections or changes to this application after approval has been obtained from
NOTE: A charge of 31.00 will be made
the 1'Iannir,;; Iiu.rrd.
A re 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.