1260 NE 99 StMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statenient 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 specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Registered Architect and /or Engineer qr /' i
Owner's Name and Address_ �• rA
Street and Number where work is to be done
STATE OF FLORIDA,
COUNTY OF DADE. ss.
of the above descri
therein by him state
Chairman
Member
Member
�J
Permit No Date , ,__` _
Disapproved . J mate i � 1�
( Signed) - - c �i rjt 7 fj, ' j il /
=
uildi� 1npector
PLANMING B
Council Approved
Name and address of licensed contractor / j e
Location and legal description of lot to be built on:
Lot Block
CJ) - -��
State work to be done and purpose of building ,( by floors)
� c
and who, being by me fist duly sworn, upon oath deposes and says that he is the
s ruc
on
ue.
Date
Date • 4
No /c. _rr 0 Street "JS j
7
New Building Remodeling___ Addition ) 1 ''''' '-- Repairs No. of Stories
To be constructed oft _ Kind of foundation__�_� ,-' n �''e SW of Cove- - 4 " �� � -
Estimated Total cost of improvements $__ 4) 6 S-12- Amount of Permit $ ®
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor_ ___
Read, Sworn to and Subscribed before me.
and for no other purpose.
, 19`
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 k/ The undersigned applicant for this building pp g 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 public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village. t) t
Remarks
(Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
that he h ` efully read t e f oregoing application, and that he did sign the same, and that all facts
Notary Public, State of Florida
My Commission Expires
ARD DATE
Member
Member
Member
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.
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Application is hereby made for the approval of the detailed statement: of the plans and specifications herewith submitted for tha 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.
Zone cubage required
Distance to next nearest building__ P
STATE OF FLORIDA, 1
COUNTY OF DADE. j
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT.
ss.
MIAMI SHORES VILLAGE
Owner's Name and Addressl (-Y ,
Registered Architect and /or Engineer
A I l/:: -', (t ---4- e , Name and address of licensed contractor �_' _ L f t
Location and legal desgiption of lot to be built on:
Ja i
Subdivision ^ 4 f ' ' t'
" 2 C C, iL . i c 2
Street and �Number ' wh e wort is to e done
X 71
tate work to be ( done and purpose of building (by floors ) _ ______ �(l
Date ,19
No Street
Notary Public, State of Florida
and for no other purpose.
. Building Remodeling Addition Repairs No. of Stories
To be constructed oE Kind of foundation_AXM
Roof Covering_ ___t
7 f a
�' C>>
Estimated Total cost of improvements $____ ° �Amount of Permit $
alai Cubage
(:) _____ __Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications or said building. All notices with referegcp to the building and its construction may
be sent to -- / /1__ .`�-�--v-'' --- - - - --- -=
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 public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) [� r� ,c i > V / v/ !
J� (1 -A
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared —
to me well known,
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 / r ® Date _
ate / �S ? Read, Sworn to and Subscribed before me.
Disapproved Date
( Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman 'Member
Member 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 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 '
materials and /or workmanship.