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351 NE 98 StLocation and legal description of lot to be built on: Lot Ac IC) Block 41' Subdivision Street and Number where work is to be done .,r/ A' . 0 State work to be done and purpose of building (by floors) Disapproved Date (Signed) MIAMI SD=I®i ='ES 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 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. /� Date j.._9 ,19 �/ Owner's Name and Address . H.4 .`�..� }� .._._.___ No. _3 / Street /VA �d" 5'� Registered Architect and /or Engineer /��/� .e� /f 6Jp4 1/ / 5 Name and address of licensed contractor _____.N/ /q/ J . 4. 0.4 / ) f ,2 3 /- t‘ 7.7 �r ?. 7E 7' /oA' -- 41) 1 / n?, and for no other purpose. New Building Remodeling Addition. To be constructed of Kind of 4.3-14:11 foundation__... _ _ ... Roo v ng , 0..4 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 Repairs No. of Stories Notary Public, State of Florida 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_ 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, Com.' d General Laws of Florida, Permanent Sup pkcent, and has complied with the provisions thereof, and will require similar compliance fr all contractors or sub - contractors en loyed m by him in the work to be performed under this permit; and will post or cause to be posted spec .n the site of the work p ublic notice or notices as are required by the Act. The undersigned agrees to employ only such . o. actors, on work to be ed under this permit, as are licensed by Miami Shores Village. Remarks (Signed)__ v''•(...a'2.— STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to adn nister oaths and take acknowledgments, .ersonally 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 Read, Sworn to and Subscribed before me. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman 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 been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.