857 NE 98 St•
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed state „„•nr or me plans and specifications herewith submitted for the build
inc 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 iuilding 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.
1 ��1
I
nn 'l. —
01/4k-ncr's Name and Address . e ' G0._ .. — No.... -� � _. Street._.._...�..� ...} 1 .
Registered Architect and /or Engineer
Name and address of licensed contractor P' g • 6...0 • L'A
Location and legal description of lot to be built on: qq i , � -
Lot t`1 Block r . Subdivision Mt 0 0 4 /1. C Lt x. �cl . 41 .S
Street and Number where work is to be done S J �-- ( 16 -4 1 . 1 1 -C42:4 —
State work to be done and purpose of building (by floors) (a.1 4.C?
_.._. and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories —
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 00 Amount of Permit
Zone cubage required .Plan Cubage
Distance•to next nearest building a Size of Building Lot
Maairnum 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
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Ce ral Laws of Flo
and has complied ssith the provisions thereof, and will require similar compliance Irvin all •n ractors or s
in the work to be performed under this permit; and will post or cause to be posted for inspe tin on t e sit
or notices as arc required by the Act. The undersigned agrees to employ only such subco_• • ors, o• wo
pcnnit, as are licensed by Miami Shores Village.
Remarks
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
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
thcrcin by him stated are true. V -
Permit No . 1 94 Date f i./ L T Read, Sworn to and Subscribed before me.
Disapproved Date
( Signed)
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
QL -?
Notary Public, State of Florida
My Commission Expires
igations as an employer
da, Perm;rnent Sup pleuaent,
ntractors employed by him
the work such public notice
be performed under this
PLANNING BOARD DATE
Chairman Member
Member Member
Member . . Member ...._ ._ -....
Council Approved Date Disapproved Date
NOTE: A charge of 31.00 will be made for making corrections or changes to this application after approval has been obtained frrnn
the Plannir.;; Board.
A rc- inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.