253 NE 99 St (3)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING P
Application is hereby made for the approval of the detailed state.. or roe plans and specifications herewith submitted for the build
ine or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florid.I. 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 progreu of the work. -
'/ �W. '/ Date q ,. rr .,.._._
Owner's Name and Address fl 6t1.7 - / ?y � � �4 N C .q!!: Street_... ?L . ls........... _.
Registered Architect and /or Engineer• Hk� �?•'Y.%/ ., .... « -- «.•.• ,
I V e
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivisio
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Building Inspector
.and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation 6 00
Estimate Total cost of improvements S. r ®mC Amount of Permit $. 6►. y
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
Maaiunum 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 budding and its construction may
be sent to..
Tie un.lersicr,c(1 applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied ss nth the provisions thereof, and will require similar compliance from all contractors or sub - contractors employe 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
perrnit, as are licensed by Miami Shores Village.
Remarks « (Signed) etetkd
STATE OF FLQRIDA,
COUNTY OF DADE. j ss.
Before me, the undcqigned 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�e true. T v i
Permit No , Date 1 %1 )1 I 110 Read, Sworn to and Subscribed before me.
Di sapproved � Date.._.. ,._.........._.....__.
Notary Public, State of Florida
(Signed)
My Commission Expires., ,
PLANNING BOARD DATE
Chairman , Member r T . r
Member _ Member t ...._
Member .. , _._ Member r --,.
Council Approved Date Disapproved Date
NOTE: A ch.irge of S1.00 will be made for making corrections or changes to this application after approval has been obtained fmm
the Plarinir tto.ird.
A re- Inspection Ice of $1.00 will be charged when such re- inspection is made necessary by impropcs notice for inspection or faulty
materials a nd /o workmanship.