285 NE 98 St (3)Registered Architect and /or Engineer
Name and address of licensed contractor
Street and Number where work is to be done.
Stale work to be done and purpose of building (by floors)__
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Chairman
Member
Member
Council Approved
Building Ins ctor
MCAx'10 SHORES V0[tLAGE
ll °_t.DING INSPECTION DEPA T ENT
Location and legal description of lot to be built on:
Lot__ ti 3 Block 3 �O q ▪ Subdivision.
rFFLDCA N rF0' r� = :`.UILD9NG PE MIT
Application is hereby made for the approval of the detailed statement of the 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 progress of the work.
b Date
Owner's Name and Address _ _ CM/ 4 C - ____.___ Street_NE
0® ti ` d 0
(52' C / 3 ,,.-._
3_1rRT .
4r.
1•
1'
and for no other purpose.
New Building • Remodeling Addition N Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $_ Amount of Permit $
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
0 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 of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance fro .11 c.. +; actors or sub ors employed by him
. in the work to be performed under this permit; and will post or cause to be post or ins � ' n on the sit . the w. rk such public notice
or notices as are required by the Act. The undersigned agrees to employ only sch su.co o .' on w. to . .erfo d under this
permit, as are licensed by Miami Shores Village. /i t
Remarks --- - (Signed � C ` ,�> , -
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 tr // ue.
Permit No 1.i_7 Z S ' Date / - L- 6 7' Read, Sworn to and Subscribed before me.
Disapproved C � P‘: to -
Notary Public, State of Florida
(Signed) � -
My Commission Expires
PLANNING BOARD___ ___.. DATE
Member _._.
Member
Member
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 51.00 will be charged when such re- inspection is made necessary by improper notice for insp., ;ion or faulty
materials and/or workmanship.
A lt
Cog_aGg
MR_ c C c t .
H6 99 7,
(dim sJi2T
)4O / S
5 / 96Czm --dc,
ME Pe
kg
r
?oak,
� (� ,4 ra : Sett a %t ,;,
J Aft ,L %.4 14
E � or'_e. S . v
&T. 3
4 c 1 , 5 6L