1286 NE 99 StOwners Name and Address . &
STATE OF FLORIDA, t .
COUNTY OF DADE. ss.
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ur the plans and specifications herewith submitted for the build •
ins 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 Divisinn 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 pregreu of the work.
D ate..._....__.
.... No.. !a.
Registered Architect and /or Engineer ,,., ,,.• •. „4,,, „,,:,..,. ,.r„Z ^,,t,
Name and address of licensed contractor..
Location and legal description of lot to be built on:
Lot Block p lau,2 /`__ Subdivision n n
Street and Number where work is to be done icg _ \t ' • .... 4L:1_ . T
Building Inspector
Chairman
\f crnber Member
Member .. ... _....._......_..._._.... »....._ Member
Stato work to be done nd purpose of buildin (by Boo s). P ..._..., i
_..__....:...... for no other purpose.
New Building Remodeling v Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $... r 00 0 , Amount of Permit $.. / 5 ”.
Zone cubage required plan Cubage
Distance .to next newest building. Size of Building Lot
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 uiuicrsigncd applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of l.thur under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied w ith the provisions thereof, and will require similar compliance From all contractors or sub - contractors employed by hint
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 s}fbcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remuks _. (Signed)
Notary Public, State of :Florida
- -9- .. 7 . . . I9
—. Slreet..tl & 7 9. _ J!1....,.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared niQr)-
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the. OV
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, an that all facts
therein by him stated are true.. LL
Permit No.._....J ..�. S� �a Date 4 .5 7 .... : .._._ Read worn to and Subscribed fore me.
Disapproved , • . t _ Date.
My Commiuion ExpiresNQlk.L. »4!ttt I t om.. ' .:, w ' ': i` . : ` P -` "'A KLA
MAY COMMISSION U(PIR�S JULY /5- MT
PLANNING BOARD DATQOIwD€D NUJ GENERAL tNS 'UNDERWRITE'S
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 PI. nnir.;; 11o.trd.
A re- inspection fee of $1,00 will be charged when such re-inspection is made neceuary by Improper notice for inspection at faulty
materials anti /or workmanship.