777 NE 98 St (8)BUILDING INSPECTION DEPARTMENT
",- FLO AVON FOR EiUJLL®0NO PE MUT
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. , / D
Date. .._1 , 19.)/
Registered Architect and /or Engineer c s ! P-� r/
Owner's Name and Address t/ 1 L 1/. , v ` ( fit ,r /
No Street__
Re e A o r" r Ce
r �
Name and address of licensed contractor ( Ile,- eL plizit 1 l.. o _ 1 /" CG `l L
Location and legal description of lot to be built on:
Street and Number where work is to be done
Permit No
Disapproved
(Signed)
_1,3)4
Date
ate
Building In ector
(E)
Chairman
Member
3f amber ..... ___
Council Ap .:cvec.. Date
ViLLLAME
Lot 2 et 3 Block 7 ( Subdivision t ` (.1.4 J S Gk. B/' s cC C'
Read, Sworn to and Subscribed before me.
PLANNING BOARD DATE
�. m e
• � s e 0
State work to be done and purpose of building (by floors) 2 0 e & t-o-e) 112.e _._ -____12-9,c
and for no other purpose.
New Building t� . Remodeling Addition rr Repairs No. of Stories /
To be constructed of. .__ t3.. Kind of foundation Q c1 C Tom oof Covering 'r't `� e ..
d $. '`
Estimated Total cos: of ins rovements �.. ..� Amount of Permit
Zone cubage requred _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 rlorida 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 a site of the work such ul lic notice
or notices as are required by the Act. The undersigned agrees to employ only suc . subcon ctors, work to be perforyrt / der this
permit, as are licensed by Miami Shores Village. 1
Remarks (Signed) ''(_ -
STATE OF FLLG"r ;IDA,
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.
3 7
Notary Public, State of Florida
My Commission Expires
Member
Member
Member
Disapproved Date
• NOTE: .'. c:..rge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Pi :uning
A re :r. .. _,ion fee of S1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
r..ateriaa a:.., u. workmanship.
CAD- 5�