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390 NE 98 St (16)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 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 her specified 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. Disapproved Date (Signed) MIAMI SHORES VILLAGE State work to be done and purpose of building (by floors) PLANNING BOARD Chairman Member Member Member _ Member Member Council Approved Date Disapproved Date_ Location and legal description of lot to be built on: ' Q Lot___ —_ Block_______ ,_ —_ Subdivision • �� �� ' G "" Street and Number where work is to be done and for no other purpose. New Building __________________________ Remodeling __ Addition___ Repairs k No. of Stories_ To be constructed of__________________ Kind of foundation _ Roof Covering_ Estimated Total cost of improvements $____ © -' — __Amount of Permit $ O' Zone cubage required Distance to next nearest building 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 Supplement, and has complied with 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 in pection o e site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcc�tract9is, ork to be performed under this permit, as are licensed by Miami Shores Village. Remarks _Plan Cubage Size of Building Lot _ ________�_ No�- -- Stree �. (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared 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, Swor Building Inspector My Commission Expires and Subsc 'bed befo me. Notary P :lic, State of Florida DATE to me well known, 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. Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor Location and legal description of lot to be built on: Lot___— ________ Block_ __ Subdivision Street and Number where work is to be done_ work to be done and purpose of building (by floors) Permit No._ —__ Date Disapproved Date (Signed) MIAMI SHORES 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 buildii or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shon 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 specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date_ 19 No. Street__ 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 Notary Public, State of Florida and for no other purpose. New Building ___________ _______________ Remodeling________________ Addition_________________ Repairs No. of Stories__ d To be constructed of Kind of foundation ________________________ Roof Covering____________ _______ ��— Estimated Total cost of improvements 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 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 Supplement, and has complied with 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 permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, t COUNTY OF DADE. 88. 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 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. 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.