1259 NE 98 St (14)Owner's Name and Address fl 44
Registered Architect and /or Engineer.._. _
Name and address of licensed contractor__ ..
New Building Remodeling
MgAMI SHORES VILLAGE
91 DING INSPEC"'lON DEPARTMENT
APPLY'. TION FOR BUILDING PERMIT
Application is hereby made for the Lpproyal 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 specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
r,
Date_
PL BOARD_. -- _ DATE
Chairman Member
Member Member .. _.
Member ..__ _ Member
Council Approved Date Disapproved
Date_ /� t �C
No �+' 'r 9 Street. (Q 1� d ,.
Location and legal description of lot to be built on
Lot Block Subdivision /2 r ' N. ' ? r .
Street and Number where work is to be done ,�I./I n 0 / ,(3. IV _ .in A E C F
State work to be done and pi pose of building (by floors ) __
Cv,.tc t 7t
and for no other purpose.
Addition Repairs No. of Stories
To be constructed of Kind of foundation oof Covering
Estimated Total cost of improvements $_fcr 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___
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 Florida Workmen s Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent 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 th ite of the work suc public notice
or notices as are required by the Act. The undersigned agrees to employ only such s tractors, c vork to perf� ed under this
permit, as are licensed by Miami Shores Village.
Remarks -- - - - - --- — ( Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
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 07
Disapproved Da
( Notary Public, State of Florida
(Signed) -',"� ! L -- - -
Building Inspecto My Commission Expires__ __ ___
Read, Sworn to and Subscribed before me.
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has b -r obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper no for insj : on or faulty
materials and /or workmanship.
`L—wE
-kt4 1gvAt—t— vjtc,ibf-3