73 NE 99 St (13)ROOD1114-
Ar
or
A
Bui
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 a' building during progress of the work.
Owner's Name and Address....:t-Q.L P s TO U T
j No
Registered Architect and /or Engineer. -.. _ .. 4EC P eg e , 4 Q % K_
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lott n-__ -. ._ Block I Subdivision
Street and Number where work is to be done 1 3 C
State work It) be, d e and pur ose of building (by floors)... •
New Building
To be constructed of
STATE OF FLORIDA,
COUNTY OF DADE. ss
MIAMI H RES VILLAGE � � 2 J D
BUILDING IN ECTION DEPARTMENT
APPLICATION FOR BUILDING PERMI /j
/67_ fir/
Date L"f l C , 19 S7
CF o K eo H ST U TIO N ' 0 1
Street
and for no other purpose.
Remodeling Addition v
› Kind of foundation e
Repairs No. of Stories
Roof Covering gnu
Estimated Total cost of improvements $ g o Amount of Permit $ 0 o
Zone cubage required .Plan Cubage 9 S 2- _
Distance to next nearest building Size of Building Lot _.. 1 ( -
Maximum live load to be borne by each floor
I hereby submi a the plans and ,_. iifications r said bui ing. All noti s ith reference t e ilding its co s uction may
be sent to ll
The undersigned applicant for this building pennit 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 on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su s ontractors, ork to be .perfo d 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 ap-
peared
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 foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No 7-30 _ Af -. Date ��� - ______$gad, Sworn to and Subscribed before me.
Disapproved f
( Signed) -. -- -
otary Public, State of Florida
Building Inspecto My Commission Expires
/
P NNING BOARD DATE
Chairman Member
Member 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.
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Owner of fi uiid+ g ..
Architect... .
Contractor or Builder....
This permit is hereby issued L'
the building above deiseShetl, as . ±
press eanglitiou that an facts stet,
submitted,, and in adalOrdance ands,
e£ NI'aini Shores Village, Alla ref
time upon the violation any ..
asathetized by the b gild g. nspeC1
In consideration ion o£ tire isst#a ke to
application and .tvIano and specifications
$tate of Flericta, all the buildinig .o n
Miami Shores VS! e.
;'717O e Li
f r! . 1!, i •X .' ` . aita f.,.fr .fit. �t.:q.