1199 NE 99 St (13)STATE OF FLORIDA, 4
COUNTY OF DADE. ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
•
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 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 spe • ied or not. A copy of approved
plans and specifications must be kept at building duripg progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Block
Lot
Street and Number where work is to be done
State work to be done and purp8.. of building
/tile / 1 . • _
New Building Remodeling
To be constructed of Kin
Estimated Total cost of improvements $ __.
Subdivision
b floors)
Addition
Member w_ Member
Member Member
Council Approved
Date
'AV
Repairs_
Roof Covering
Amount of Permit $�
_Plan Cubage
Size of Building Lot_
PLANNING BOARD DATE
Chairman Member
2'2 02
No. 11) Street_
Remarks (Signed) i
19'
and for no other purpose.
No. of Stories__
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building.
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's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with 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 the site of the work such lic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, o work to be per or :r t der this
permit, as are licensed b y Miami ' i Sh ores Vill age.
All notices with reference to the building and its construction may
Notary Public, State of Florida
ilding nspec or My Commission Expires
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me first duly s upon oath depo s and says that is the
of the above describ d construct he has cjk£ulre the for mg application, and that he did sign the same, and that all facts
therein by him st . e true.
Permit No �! i ate �_� �_� Read, Sworn to and Subscribed before me.
Disapproved ________
( Signed)
to me well known,
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 Planning Board.
A re- inspection 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.