351 NE 98 St (12)APPLICATION F',R BUILDING PERMIT
Application is hereby made for the approval of the det-dled statenien' of the plans and specifications herewith submitted for the build-
ing or oilier structure her a described This : pplicatic.. is made in compliance and comorimty w,th the Building Ordinance of Mia;
Shores Village, Florida, and all pro isions of the Law i f the State of 1- h.rid.. all 0. d•nances of Mi .ii Shores Village and all rules and
regulations of the Building Div':: ,i of \liam; Sho:••• iilage • h '1 e o. ipl,ed wi_h, whether herein specified or not. A copy of approved
plans and specifications must be key. at building durin,_ progress of tic wcrk.
Owner's Name and Address.
Registered Architect and /or Engineer _
Name and address of licerhed contractor .
Location and legal description of lot to he built on
Lot. _ Block.
Street and Number where work is to be done
OAMO SHORES VILLAGE
BUILDING INSPECTION DEPARTMEN'
r r Street.
.. -.4 ✓ / - aN l`l tit ilk'
Subdivision
Date
State work to be done and pur ose of building (by OUttiON./ C
- . 19
and for no other purpose.
New Building. _ Remodeling. _ ____ _ .- Addition.- ... _ _ __ _ Repairs _ No. of Stories
To be constructed of .. Kind of foundation _ _____ _ .. . Roof Cov'ring _
� '`
Estimated ;tal cost of improvements $.. c) Amount c ` Permit $..
Zone ^ubage required
Distance to next nearest building_.
Maximum live load to be borne by each floor
1 hereby submit all the plans and speciii..ations for said building. All notices with reference to the building and its construction may
be sent to... - -- - -- - - ---
The undersigned appli ant for ails building permit does hereby certify That he understands and accepts his obligations as an employer
of h under • he Florida Workmen's Compensation Act. being S. ;-tion 5966, Con-piled Gen -al Laws of Florida. P r. an:-n S ippl nest,
and h .s compl ed w;th • he prov' .ions thereof, and will require similar coinn lance from all contractors or sub contractor., cniplu -ed by hint
in the wo k to be p .ri - med under t peril it and will post or came to be posted for inspection on the site of the work su h public not e
or '•otiees as are regwr d by the Act. The u el, r !gm-el agrees to employ only such ..ibcontr. ctors, on work to be perform d . der this
permit as are licensed by M am, Shores \ i!!:g4e.
Remarks. (Sig•ied )
Plan Cubage_._... ...
Size of Building Lot
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ..nd take acknowledgments, personally : p-
peared
to me wel! known,
and who, being by me first deli , worn, upon oath deposes and says that he is the ..
of th abov. de ,c died istruction. t. , li. has careially read the foregoing application, and that he did sign the sane. and that ..l - .let'
therein by him stated are tr te.
Permit No _ Date. Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Building 1 P ctor
PLANNING BOARD
Notary Public State of Florida
My Commission Expires.
.DATE
Chairman Member . ... __._
Member __.- Member
Member _ Member
Council Approved
I)atr Dieat.proc •'1 . - Date
NOTE: A charge of $1.00 will be made for snaking corrections e- •lcinges to this application ft:-r approval h ;s I; Pt it ht:ri.ed from
the Planv ng Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is mi ;r• nceessar:, h,• improper notice fc r in.p. t or I.L. ty
materials and /or workmanship.