801 NE 98 St (9)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 strw ture herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Villags, Flonda, and all provisions of the Law of the State of Flor•da, 311 ord'nances of Miami Shores Village 'nd all rules and
regulations of the Building Division of Miam Shores Village sh 11 be co ..plied with whether h - r in specifie- not. A cop of apt. rove d
plans and specifications must be kept at building during progress of the work.
��/��� ci Dat _ -
Owner 2
s Name and Address __ // o _
// __ _ _ _ ____ No. Street__ _
Registered chit et ° --1 ' --- Engineer.__._ )2R 2 N—
Name and address of licensed contractor _+�L/ _ 7 i L� - CD/��O cp 94O / 7 7 ,4 ti
Location and legal description of lot to be built on:
Lot$ /3 _ ! - ( J 7 2 , / _ 1 ' _ . Block ___ 7____. __ ___ subdivision__ ) l
Street and Number where work is to be done
Chairman
Member -
Member
Council Approved
Building Inspecto
MIAMI SHORES VILLAGE
Date _
State work to be done and purpose of building (b floors)____.._
O ff _ 1J,4T/ l� 7'L2 .L`LpQ (_c
New Building_______ ___ ___ _ . Remodeling
To be constructed of L> f 5C/_24) Kind of foundation.
Estimated Total cost of improvements $ _ cS. Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer
peared
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
therein by him stated are true.
Permit No.
Disapproved
( Signed)
PLANNING BOARD
Read, Sworn to
Member __
Member
Member
Date Disapproved _ _
!_ s
0 )2E 5' 55 z
and for no other purpose.
Addition_.__ ___._ Repairs No. of Stories
Roof Covering __.__ J7C4?.. !L�_
OH` [ e� -�<
.. see° � �r -fro .
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 _
1_r12 .o -yeQ_ Gz2/2 ' l _ ?__oQ 7 7 A x.
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
m 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 public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work e be,per�ermedynder this
permit, as are licensed by Miami Shores Village.
Remarks_ _ (Signed) __
oaths and take acknowledgments, perso sally ap-
application, and that he did sign the same, and that all facts
and Subscribed before me.
Notary Public, State of Florida
My Commission Expires __
. . __ DATE
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after appr ..1 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.
1 611
19__
--
■
__ to me well known,
__ Date
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