857 NE 98 St (3)Street and Number where work is to be done
MIAMI SH o RE S VILLAGE
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 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 bui ng during progress of the work.
Date
Owner's Name and Address Q L y - V No Stree �0 %' / °�
Registered Architect and /or Engineer .Jr? • �_D
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot _,& / Block 7. Subdivision__.__.." _e./• a■-"TCG'.
State work to be done and purpose of building (by floors) ,- s ' ' Y ' S
ate! G G A p9- • ;/
----- - - - - -- and for no other purpose.
New Building .7 Remodeling Addition Repairs No. of Stories /
To ' constructed e ,3- Kind of fo dation Roof Covering ,� ' < < �j
Estimated Total cost of improvements $
rfit GO
CC Q C
Zone cubage required __Plan Cu age _
Distance to next nearest building t1:2A iTe . ' Size of Building Lot a X i 0 i
/
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices i 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 Supplement,
and has complied with the provisions thereof, and will require similar compliance m all contractors or sub- ntr tors employed by him
in the work to be performed under this permit; and will post or cause to be posted r inspection on th oft ork such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sub ontractors, or , t. .: performed under this
permit, as are licensed by Miami Shores Village.
Remarks____ ( Signed)
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
Notary Public, State of Florida
ommission Expires
to me well known,
and who, being by me first duly s' / ': ' dep. ses and says hat he is the
of the above described co ction, that he
therein by him st.ted are y read the f regoing application, and that he did sign the same, and that all facts
/: -
l � � D
Permit No .ate__ „ __. ! D tRead, Sworn to and Subscribed before me.
Disapproved
( Sig
PLANNING B RD DATE
Chairman Member
Member 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 inspection or faulty
materials and /or workmanship.