133 NE 99 St (5)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 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 AJ .-S J r t ___
Registered Architect =and /or Engineer �.
Name and address of licensed contractor
Location and legal description of lot to be built on:
7"0 Block _42 Subdivision
N
Street and N ber where work is to be done
State work to be done and purpose of building (by floors)
New Building
To be constructed of
Estimated Total cost
STATE OF FLORIDA, +
COUNTY OF DADE. j Ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
• �uiCP C°oaic Lo% elt/c t7" _
Nu_ LeS . 71/4,4 1 LQ'FRoat Laic) B 4-03r Vref no other4rpo G .
Repairs No. of Stories
8pi Q.
Remodeling • A dition
Kind of foun ti MV 1")
of improvements $.._
Disapproved �/ Date
(Signed)
Chairman
Member
Member ._._.....
Council Approved
Member
Member
Member
Date
p 2 f.
, 19.0
No. .a3 Street.. t. f. ..� ...
LANNING BOARD DATE
Roof Covering
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, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em toyed 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 subcontract °, on work to /be perform d under this
permit, as are licensed by Mianf Shores Village.
Remarks (Signed')
s"
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 Date i� � , Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
Z lag. ALL
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G Q 't �
AO
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