841 NE 98 St (11)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.
Owner's Name and Address �- �- /4/6 .1./C ! No... Street .....". � / +r•
Registered Architect and /or Engineer ,, .6 . ,9/e. O
Name and address of licensed contractor / 4?. ',g'
Location a d legal description of lot to be built on: �j
Lot 1 � / 7 Block 72 Subdivision .�'�, � - ..1 _ 4.1; � 3 x
Street and Number where work is to be done E 4 1 ___1\1 LT 1_ - _ `s_T•
State work to be done and purpose of building (by floors) V ,g7 ` - S,
New Building 1f
Estimated Total cost of improvements $__
STATE OF FLORIDA,
COUNTY OF DADE. ss.
APPLICATION FOR BUILDING PERMIT
Distance to next nearest building
be sent to
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date
Date
/Read, Sworn to and Subscribed before me.
and for no other purpose.
Additi Repairs No. of Stories
Remodeling
C� B- Roof Coverin c - 9—
To be constructed of Kind of foundation g l
0 ,Q
unt of Permit $
Zone cubage required ..r� 00 0 an Cubage__ /
_Size of Building Lot .. e'X / /
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
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 Geral Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all ontractors or s . -con .actors employed by him
in the work to be performed under this permit; and will post or cause to be posted foriiii action on th •. it:.f. work such public notice
or notices as are required by the Act. The undersigned agrees to employ only sucs'sub tractors, o; wor . .e performed under this
permit, as are licensed by Miami Shores Village.
Remarks___.. (Signed) ___ AC" j
Before me, the undersigned authority, a notary public, duly authoriz to administer oaths and take acknowledgments, personally ap-
peared
- - - -- to me well known,
and who, being by me first duly sworn, upon oatI,dep ses and says that he is the
of the above described construction, that he has-t ; ref}fjly read the foregoing application, and•that he did sign the same, and that all facts
therein by hirn stated are true.
Permit No
Disapproved / l� fe
- -` �'�°' Notary Public, State of Florida
( Signed) / "' ,l' n, , 0
Buil. ing Inspeetor i My Commission Expires
PLANNING BOARD n i 4 — DATE
IT Chairman v 1�_ i - Member
�i
Member 'IR L7 -- Member
Member _ 7T-' :.,..I2.12 , . ) _,_ _,__i Member
Council Apprdved ate 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 inspection or faulty
materials and /or workmanship.