381 NE 98 St (11)APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement ur me plans and specifications herewith submitted for the build
inc or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Flnrid.t, 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 roust be kept at building during progress of the work.
Date.. ._!.�.r___.___..._.__..._.... ,19.._._
Owner's Name and Address r? R. -3 fir iL _ No. . Street
Registered Architect and /or Engineer . ,t,. ,f. ••,..•
Name and address of licensed contractor r G A I R.— .. /V • !h
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ' L..._iv /F q S . S j • h IP d 1 S /let — S
State work to be done and purpose of building (by floors S L14. ! _.... o o /' o S i &' ro- ;,_,_• „__ - _,_
( g 1.L._..._..3:>!.a..e- �'A C/c 4 c - p.:_/_?, fat ■7 re it 0 i?
and for no other purpose.
New Building Remodeling 'V Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimate Total cost of improvements $ O Amount of Permit S. ! E !
Zone cubage required Plan Cubage
Distance • to next nearest building Size of Building Lot
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 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, Compiled General Laws of Florida. Permanent Snp c lement,
and has complied milli 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
pcnnit, as are licensed by Miami Shores Village. r
Remarks (Signed)..
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 t � es
Permit No..___ ( _v Date 7.)_ .L.i Read, Sworn to and Subscribed before me.
Disapproved ok Date
\ 1
(Signed)
Building Inspector My Commiuion Expires
Chairman
Member
Member _.....__....._..._._ .._._
Council Approved Date
NOTE: A charge of $1.00 will be made for
the 1'I.rnnir.;; Ilu.rrd.
A re-inspection fce of $1.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Notary Public, State of Florida
PLANNING BOARD DATE
to me well known,
Member
hi ember
Member ...._ — .._.....
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by Improper notice for inspection on faulty
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