304 NE 99 St (8)Disapproved. Date.
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby utndc for the approval of the detailed statement ur c 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 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.
Date. !_ 1-20 1 9 .
Owner's Name and Address . t' it'AP V' J( .... ./ . fd 0 b -. ._ No..: ...» . Street.06M .9J T
Registered Architect and /or Engineer S 6 at enrt
Name and address of licensed contactor // T' _
Location and legal description of lot to be built on:
Lot Block Subdivision ..._.. ---- . _.. —
Street and Number where work is to be done.334 ft /.t .. — _
State work to be done and purpose of building (by floors) 6 eat 23 OPP _._.. . ._ .. ....._. ... _.� _..__
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories 0
To be constructed of Kind of foundation Roof Covering
e00
Estimate-3 Total cost of improvements S 6 •`-' 0 a • Amount of Permit 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 the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
i & M e ) ai i 305d Ne ff ST spy0e ,,r .. Y fi5f
The undersigned applicant for this building pennit 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 Nlith 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 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 su ntractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village. , r
Remuks (Signed) ' r
But ding nspector My Commission Expires
STATE OF FLORIDA,
COUNTY OF DADE. j H
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 ii Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
PLANNING BOARD DATE
Chainnan 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 hecn obtained from
the Plutnir.;: 11o.ud.
A re.in.pct•tion fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection es faulty
materials and /or workmanship.