1279 NE 98 St (7)Location and legal description of lot to be built on:
Lot Block
Street and Ntunber where work is to be done
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ur me plans and specifications herewith submitted for the build
in 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.
,19 ..1
Owner's tame and Address ... � e./7.17/< No.. - Street Registered Architect and /or Engineer
Name and address of licensed contractor
work to be d ne a urpose of building (by (loon) S ......l.J
'lace y2- �� C 11.
Date
Building Inspector
Subdivision
New Building Remodeling Addition
To be constructed of Kind of foundation
Estimated Total cost of improvements
Zone cubage required
oft
�cl s
Repairs No. of Stories
f Severing
Amount of Permit $. c "t
_Plan Cubage
Distance .to next nearest building. Size of Building Lot
Maximum live load to be borne by each floor
I hereby su mit all the plans and spec' 'c tions for said build' g. All f otices with ryfeence t
be sent to.. caw " etc- 7 s '('i . ,�, 3
The undersigned applicant for this building permit does hereby crrtify 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 in pection on the site of he work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such s ntracto pq / woor e performed under this
pcnnit, as are licensed by Miami Shores Village.
Remuks (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
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 e true.. Permit No. 714 1.Le'.l , Date 1` 1 .. � ............_._ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
and for no other purpose.
b ng and its construction may
/eon 3s/6/
to me well known,
PLANNING BOARD DATE
Chair :Ban 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 faulty
materials and /or workmanship.
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