130 NE 98 St (6)m S- Sa- /i) MIAMI SHORES VILLAGE
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Ossncr's Name and Address . of E L2 iie0 S �.. ' —
Registered Architect and /or Engineer
Name and address of licensed contractor
State work to be don and purpose of building (by floors)
BUILDING INSPECTION DEPARTMENT
PLICATION FOR BUILDING PERMIT
{ +t +liration is hereby mode for the approval of the detailed statement or ism 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 prpgreu of the work.
Occhvk
and who, being by me first duly sworn, upon oath
of the above described construction, that he has c
therein by him stated are
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Permit No.. ...�t?4. Dale / / ..
3
Disapproved ... Date.
(Signed) & .
Building Inspector
Chairman
Member
Member .. _....._......_..._._.
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the 1'I.innir.;; Board.
19.:
No. ..if..3CO ./.Str
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Loe and legal descriptioni' lot to be buil on:
LotO) (.Q1..b � � QeD. l 'o' Iflock 1 ' Subdivision. .
Street and Number where work is to be done 1 3Q ( /1 ......_.
_........ ....- _... —..— - and for no other purpose.
New Building Remodeling Addition X Repairs No. of Stories
To be constructed of Kind oundation Roof hovering
Estimated Total cost of improvements $ ( J
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..
. .O Q Amount of Permit ..t f
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
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 .f Florida, Permanent Supplement,
and has complied ssith the provisions thereof, and will require similar compliance from I contractors . sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted fo pection on t ite of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only sntractors, o• • to be performed under this
pennit, 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,
deposes and says that he is the.
efull read the foregoing application, and that he did sign the same, and that all facts
Member
Member
Member
Disapproved Date
or changes to this application after approval has hen obtained from
A re- inspection fce of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.