320 NE 98 St (10)A
STATE OF FLORIDA, I
COUNTY OF DADE. ss.
MOI
Chairman
.Member
Member .. _.....__....._..._. ...._....._
Council Approved Date
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
PLUCATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ur ore 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. �7 Q
Owner's Name and Address 0 8 �'9e,Q
Registered Architect and /or Engineer ......
Name :rad address of licensed contractor
Location and legal description of lot to be built on: �/ � /
Lot „a ,[ Block '� Subdiv ion 7.27/0 cl.��Z .� . ._... 1/. . 41. .OL. 0- g 7/U-3
Street and Number where work is to be done
State work to be fne irfl purpose of building (by floors).. _.. : � e._ - ll s-i---pga and for no other purpose.
New Building Remodeling Addition
To be constructed of Kind of foundation.
3 goo.
Amount of Permit S.
.Plan Cubage
Size of Building Lot
The undersigned applicant for this building pennit does hereby certify that he undcrstan
of lahur under the Florida Workmen's Compensation Act, being Section 5966. Compiled Ce
and has complied with the provisions thereof, and will require similar compliance from all
in the work to be performed under this permit; and will post or cause to be posted for ins
or notices as are required by the Act. The undersigned agrees to employ only such su
pcnnit, as are licensed by Miami Shores Village.
Retnuks... (Signe
Building Inspector
Estimated Total cost of improvements $
Zone cubage required
Distance .to next nearest building.....
Maximum live Toad 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
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
'1 i ..... *2.3 40E_ .
2.4 3 7
Repairs No. of Stories
oof vering
d accepts his obligations as an employer
Laws of Florida, Permanent Supplement,
actors or sub - contractors employed by him
ion on the to o the work such public notice
actors, on rk I' o be performed under this
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 garefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated ar true..
Permit No.._.. Date `Q Read, Sworn to and Subscribed before me.
Disapproved ... ( Date.
(Signed)
Member ._...._ ............. .....
.._
Member
Member __.._....— -- . --- -,.
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 I'sannir.g Huard.
A re inspection Ice of $1.100 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.