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73 NE 99 St (12)Registered Architect and /or Engineer Name and address of licensed contractor____ i,..0∎ )1L.__ Location and legal description of lot to be built on: Lot Block Subdivision Permit No Disapproved (Signed) m . ng V .ector Chairman Member Member 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 build- ing 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 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 must be kept at building during progress of the work. i t Date °"J O - S , 19 Owner's Name and Address Q' e• •44- , No Street Date Street and Number where work is to be done State work to be one and purpose of building (by floors) . 1 P -emu PLANNING BOARD DATE New Building Remodeling Addition Repairs No. of Sto 'es To be constructed of -_ Kind of foundation Rnnf (:rev Estimated Total cost of improvements $ 6 I Amount of Permit $ Zone cubage required _Plan Cubage Distance to next nearest building 10 ? Size of Building Lot mfr 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 ublic 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. - n e Remarks_ ( Signed) X1 -' O- Q- r?t CT 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 to me well known, and who, being by me first duly sworn, on oath deposes an says that he is the of the above described construction, th e has care lly rea. the foregoing application, and that he did sign the same, and that all facts therein by him stated are ;y e w Read, Sworn to and Subscribed before me. and for no other purpose. Notary Public, State of Florida My Commission Expires Member Member Member Council Approved Date Disapproved 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.