381 NE 98 St (15)Owner's Name and Address . ...
Registered Architect and /or En;incer .
Name and address of licensed contractor
peared
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
• is hereby upndc for the approval of the detailed statc.,.r•ni of me plans and specifications herewith submitted for the build
upe or other structure herein described. This application 1s made in compliance and conformity with the Building Ordinance of Miami
shores vdLige, I Inrid.i amt . II provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
roFulations of the d iilsling Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plus and specifications must be kept at building during progress of the work.
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Location and legal description of lot to be built on:
Lot Block �ubdivi
S and Number where work is to be done ,�7. ........._
State Mork don d purpose of building (by floors) ...VY`.�.
C,,air.r, in
MIcrr,ber
Member
Council Approved Date
'51:51\FIN 103
cia
and for no other purpose.
New Building Remodeling Addition Repaid No. of Stories _
To be constructed of Kind of foundation R o vexing
Estimated Total cost of improvements s.. .. Amount of Permit i...... i(a..4L ..._
one cubage required _...._.._...Plan Cubage
Distance .to next nearest building Size of Building Lot
Maaiununs 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. .. •
The undrrsicncd applicant for this budding permit does hereby certify that he understands and accepts his obligations as an employer
1.i ur under the Florida \Vorknten's Compensation Act. being Section 5966, Compiled General Laws of Florida, Perinnnent Supplement,
., nei has complied .crib the provision% thereof, and will require similar compliance from all contractors or sub - contractors employed by him
:n tl:e 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 v bcontra rs, • wotyl' to be .oerformed under this
permit, as ate licensed by Miami Shores Village.
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-
PLANNING BOARD ............. _.._......DATE
Member
Member
__.....to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
cf ti:e above described construction, that lie has carefully read the foregoing application, and that he did sign the same, and that all foots
therein by him stated are true.
Permit No.._.. , 3 0 Date . /.y. / > / Read, Sworn to and Subscribed before me.
Disapproved ,� • ; •... ... Date I
Notary Public. State of Florida
( Sig
My Commission Expires __..._...___.
Member
—
Disapproved
Date
NOTE. A charge of 51.00 will be made for making corrections or changes to this application nfter epprm•al Ins been obtained fmsu
the I'L,nnu. liu.trd
A rc•rn•pi•i nun fee of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials anu /or workmanship.
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