144 NE 99 St (3)Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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
Location and legal description of lot to be built on:
Lot Block
Street and Number where work i stobedone
Remarks
STATE OF FLORIDA
COUNTY OF DADE.
} SS.
Before me, the undersigned authority, a notary pu
Permit No.
Disapproved S \ �(\ i l Date
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
c�ye i
No. I Street ,
Registered Architect and /or Engineer
Name and address of licensed contractor 7f • //00- /�
Subdivision
/6/ 4 • ��
State work to done and purpose of building (by floors). state exteri colors (submit samples)
ew Building Remodeling Addition Repairs
To be constructed of / Kind of foundation Roof Covering
DD Amount of Permit S Zli4
Estimated Total cost of improvements S
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 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
Compensation Act. being Section 5966, Compiled General Laws of Florida, Permanent Supplement, a
compliance from all contractors or sub-contractors employed by him in the work to be performed
on the site of the work such public notice or notices as are required by the Act. The undersign
under this permit, as are licensed by Miami Shores Village.
Date
horize
(Signed) ry
uilding Inspector
Chairman
Member
Member
PLANNING BOARD DATE
Date
y
7 / , is - off
; , / �
No of Stories
Read, Sworn to and Subscribed efore me.
n Notary Public, State:af_klgr a My Commission Expires BOOM THUD GU L1AL Ia. I';D.
and f r no other purpose.
tons as an employer of Labor under the Florida Workmen's
ed with •rovisions thereof, and will require similar
post or cause to be posted for inspection
h sub . stra.rs. on work to be performed
acknowledgments. personally appeared
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 for Application, and that he did sign the same, and that all facts therein by him stated are true.
Member
Member
Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.