777 NE 98 St (10)WA M 0 SHORES VH...LAS E
APPUCATO6N FOR
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.
c =\ Date
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VwmlP ^u Namo and Address �✓r/ � e ✓✓ t � � �`a. L —_ _ %futlL -... � _
Registered Architect and /or Engineer
Permit No u 3 7 ( Date
if s
Disapproved �7___7 a i t_ Date_ -_____
C-- /[�- / - t
(Signed) - - . ... _
Building Inspector
BUILDING INSPECTION DEPARTMENT
Name and address of licensed contractor ®(4o bi " 4 ?63V a o(l A. pL._
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Location and legal description of lot to be built on: �' �► o 'Q s e
0�80ct am
Lot_ ?-i ° Block 7) Subdivision.. i_ ?!.5S.a 3 .
Street and Number where work is to be done. N,
State work to be done and purpose of building (l „ -'
O..00LDONG PERMIT
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Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Tic=" , k-) 6 l = - ` !I f. _,-. ' (i r
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I E_ � —
,_�' -A!., ;„....c,:; and for no other u
P rpose.
, /"New Building Remodeling Addition . No. of Stories
To be constructed of Kind of foundation_, Roof Covering
Estimated Total cost of improvements $ /j?-).(...e '( ,,) Amount of Permit $. 1
Zone cubage required plan Cubage
Distance to nex: nearest building Size of Building Lot
Maximum live load to be borne by each floor
I hereby suo ::it 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 r ployer
of labor under t.te Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, PennanerSuplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors a ploye by him
in the work to be performed under this permit; and will post or cause to be poste r i pection on the site of the work s6ch public notici
or notices as arc required by the Act. The undersigned agrees to employ only c sub tractors,,. on work to be performed under this
permit, as are licensed by Miami Shores Village. \
Remarks._._ _ n D
(Signed) G ..._...—_ �. 2,-- - ,"-- .
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, 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. n / , I
l�G
My- Commission Expires
PLANNIJ'G 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 - ins ectioi, •ee of 51.00 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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