821 NE 99 St (6)ef2s
Application is hereby made for the approyal 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.
Date
Owner's Name and Address ) a No...
Registered Architect and /or Engineer 77 ,,���
Name and address of licensed contractor �/!/l
Location and legal description of lot to be bu ilt on:
Lot_ . e_ GG kl.. � / ./ __ Block 14 9
Street an 1VumbeTw work is to be done
STATE OF FLORIDA, f
COUNTY OF DADE.
ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Disapproved .- �--_ /� e D
( Signed) .
ding Insp or
Street.. / 923!
State work to be done and purpose of building (by floors)
New Building Remodeling Addition
To be constructed of Kind of ou dation Roof Covering
Estimated Total cost of improvements $__ o0 Amount of Permit $
Zone cubage required plan Cubage
Size of Building Lot
Repairs No. of Stories
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, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractor r sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection o site of the w. k such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco . ' s, o p' work to be .erformed 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 the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No J"2 2? Da Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
and for no other purpose.
My Commission Expires
ANNING BOARD__. ___. DATE
Chairman Member
Member i 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 inspe, tion or faulty
materials and /or workmanship.
/v1 zf. 99vA,