825 NE 98 St (13)5 - 2-C3 `f
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby innde 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.
Owner's Name and Address WEL-6 " A. 13 Ult.-0
.__.- -... -. .. , 19_
_ No. ....._. Street.P 9 7 T N__ 5 T
Registered Architect and /or Engineer ,,:,. .,.•••, ,,.:,,,..,..,,....- ,.,,n „ -.1e
Name and address of licensed contractor (1:R L/ _ VI' SG N�OL jM f t 1 _..,t:�� I /
_..... Tie 7 6 ..
Location and legal description of lot to be on:
Lot / v- Block 7 2-- ll� ,c Subdivision qq
Street and Number where work is to be done .. .hft.Z� ....17. T N T .._._._— ....__ — .— ....._
State work to be done and purpose of building (by floors) K.CT EV C AAPF 7-r. ...._..._ _..._........_._...._.._.._ _—
_.._ and for no other purpose.
New Building Remodeling y Addition Repairs; No. of Stories
To be constructed of Kind of foundation ° Roof Covering Estimated Total cost of improvements $ 9 Amount of Permit S. ... c
Zone cubage required .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 Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Snti dement,
and has complied w ith 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 the site of the work such public notice
or noticcs as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village. Q���
Remarks (Signed ). ,E2� _ C�' 2e..-°L'��9 .. --
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
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
thcrcin by him stated g arrei tru . Q
Permit No. ._... �! a Date �� / .v_. L......_._ Read, Sworn to and Subscribed before me.
Disapproved Date. Notary Public, State of Florida
( Signed) .::.
Building Inspector
My Commiuion Expires _
to me well known,
PLANNING BOARD .._......DATE
Chair:nan Mcmbcr
Member Member
Member .. .. _.._..__....._..._. _...._...._.. Member
Council Approved Date Disapproved Date
MUTE: A charge of $1.00 will be made for making corrections or changes to this application niter approval has been obtained from
tic P1. nnir.g 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 anti /or workmanship.