857 NE 98 St (9)Chairman _. ---
Member .__. _ Member _
Council Approved
APPLICATION FOR = UILDING PERMIT
ding Inspector
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
_ _ Kind of foundation
Application is hereby made for the approval of th': det, ded statemen• of the plans and specifi,..1 ions herewith submitted for the build-
ing or o h, - ructure her i described This I t licabc is made in compliance and con•o'm ty w.th the Budding Ordinance of Mia u
Shores Villaee, or da, and all pro isions of the Laws of the State c•1 1.1,.rid. all o d nances of Mi nr Shores Village and all rules and
reign a ion. of the Budding 1)iv e of •iam Sho iilage 1 '1 e o tpl.ed with, whether herein specified or not. A copy of approved
plans .,nd specificati •n must be kct at but:d:ng durin progress of tl.e wcrk.
i Date: 19�
ccc!!! / 111 1 VVV - - - - - --
Owner' Name and Address_ -- - - - - - -. 2� , Street
° t
Registered Architect and /or Engi
Name nd address of licensed contractor.
)Location and legal description of lot to be built on:
Lot _. Block _ --
Street and Number where work is to be done
Subdivision
State work to be done r2d purpoo e of b 'Wing (by floors)
and for1no other purpose.
New Building _. _ Remodeling__ ____ _ ._. Addition___ _.__ __ _.__. .. _ Repairs. _ No. of Stories
To be constructed of ! Roof C, , ring__ -
Estimated " ;tal cost of improvements $_. (20 Amount e Permit $__
Zone ubage required. _. ._Plan Cubage___.
Distance to next nearest building. _ Size of Building Lot
Maximum live load to be borne by each floor
hereby submit all the plans and speciric ations for said building. All notices with reference to the budding and its construction may
be sent to ____ . -. _
The unde signed appli ant for th's budding permit does hereby certify Ciat he understands and accepts h;s .•bligations as an employer
of 1- For under he Florida Workmen's Compensation Act being S -lion 5966 Col p led Gen al Laws of Florida P r :men Sipple cent.
and h s comp] ed w'th he prov' cons thereof, and will require s•milar come lance from all contractors or subcontractors eiuplo .ed by him
in the wo k to be p ri med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public note c
or •otiees as are requir d by the Act. The u. d. r ign -d agrees to employ only such abcontr. ctors, on work to be perforn, d der this
permit as are licensed by M arn. Shores \ it : ge.
Remarks__ . _- d
STATE OF FLORIDA,
COUNTY OF DADE. $ Ss.
Before me, the undersigned authority, a notary public, duly authorized to adm_nister oaths ,.nd take acknowledgments, personally op-
neared
to me well known,
and who, being by me first d. ly sworn, upon oath depo es and says that he is the
of th abov de . ibed tstruction t. • 11 has careiolly read the folwoing application, and that he did sign the sane, and that all facts
therein by him state ge /
Permit No / / Dat: _ Read, Sworn to and Subscribed before me.
Disapproved
(Signed) ___
, Notary Public State of Florida
My Com:nission Expires
PLANNING BOARD __.DATE
Member _ ..
Member .
Member
.Date Disapproved
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application tfter approval h is been obtained from
the P]anr ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is m. ie necessary by improper notice for inspe. t.; r or fa. It\'
materials and /or workmanship.
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