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301 NE 98 St (2)To be (Signed) MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT • Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 regula- tions 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. Owner's Name and Address_____ Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built .n: Lot 1 & 1 _did3lock- _ Subdivision_ �+ ��' "w �1 Street and Number h ere work is to be done 3 ©J -_-Z A State work to be done and purpose of building (by floors) Estimated Total cost of improvements $ -_ Zone cubage required_ Distance to next STATE OF FLORIDA, COUNTY OF DADE. ss. -' - - Chairman Member Member Council Approved______— Building Inspector ,Signed) PLANNING BOARD Date Date -- _ e 1A — — — 19 No.- __________— Street__ New Building______ — Remodeling_________________ Addition constructed of___C ,. i___ Kind of f undation_____ C & _ Roof .Cpvering _ _ 1�P __ mount of Permit $--- -� = < _- --- - __ _ ___________ ___ _ _— Q Plan Cubage__ e L _ tea____ r?% _, V nearest building____ ____— __—_________— _______—Size of Building Lot 7■ .I / Z. +,,' Repairs 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 be sent to 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 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 are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami, Shores Village, Remarks Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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 carefu ly read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No.__ 06 _________ Date 0 Y /�� Read, Sw. ,• and Subscribed,before Disapproved _________ ___________ Date My 'Com DATA NOTE: A charge of $1.00 will be made for making corrections or changes to the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by materials and /or workmanship. t, otary Public, State of Flori ission '`Expires and for no other purpose. No. of may to me well known, Mem Member Member Disapproved Date this application after approval has been obtained from improper notice for inspection or faulty '^ .^",^ ' .' `. • � -' � • • -. , `