372 NE 98 St (12))
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APPLICATION FOR BUILDING PERMIT
Applicationois 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 specjfied 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
STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE ` may
BUILDING INSPECTION DEPARTMENT
Date_
Building Inspector My Commission Expires_
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved —__— �__— _.. Date Disapproved
_ -- 19`-1_
No . r ! —_ Street.—/Vt.. _
Locatio nd legal description- of lot tole built on: C N 6
Lot__ °� � � Block 2- Subd' i i ', ;' `� e ( -C ) (. 2 "'
,� r�� ,_
Street and Number where work is to be done____— _ ? r'
State work to be done and purpose of building (by floors) s "' vim -✓''d A!-' i'r /e °
New Building
To be constructed of t 6 '__ Kind of foundation " c- ' _— Roof Covering____
Estimated Total cost of improvements s $__/__:_,. o ' Amount of Permit $____!__ __ 77_
Zone cubage required � / A – r�
Remodeling ___ Additio — _________ Repairs No. of
5Ec /
_and for no other purpose.
Notary Public, State of Florida
_Plan Cubage
Distance to next nearest of Building Lot -
Maximum live load to be borne by each floor
I hereby suball the plans and specifications for said building. All notices wi reference to the building and its construction may
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, d Gene,Eral'Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all copfractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or c'ause to be posted for ispection,on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ntractofs,'on work to be performed under this
permit, as are licensed by Miami Shores Village.
- _
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that be 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 .5_7/ Date Read, Sworn to and Subscribed before me.
Disapproved _________________ Date
(Signed)
_r_— ______ —_ –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.
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