863 NE 99 St (5)Application is hereby made for the approval of the detailed statement 01 me 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.
r //JJ Date _..... ._..._.... , 19.. /
Owner's Name and Address . � i/Yr?' a Gam. _ No. 6:3.._.. Stree�t_Lr: ,:.:._ ,9
Permit No.
Disapproved
(Signed)
Registered Architect and / ngincer
Name and address of licensed contractor.... ‘)
Location and legal description of lot to be built on:
' ss.
APPLICATION FOR BUILDING PERMIT
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date..
Chaironan
\fcrr,ber
Member .. .. »»....._..
Council Approved
NOTE: A charge of $1.00 will be made for
the Pl.unnir,;.: 11u.rrd.
A re- inspection fee of 31.00 will be charged
materials anti /or workmanship.
PLANNING BOARD DATE
Lot Block Subdivision
Street and Number where work is to be done _..... »._..._._.. _ ...._� �.
! State work to be done and purpose of building (by floors) '1 3 "'
and for no other purpose.
Remod Addition Repairi No. of Stories _
New Building
To'be constructed of Kind of oundation Roof Covering
Estimated Total cost of improvements S - I/ Amount of Permit $.
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 crrtify that he understands and accepts his obligations as an employer
of labur under the 'Florida K'orkmen'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 from all contractors or sub - contractors employed by hint
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 notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) �-f— r�,
• dP
OP- g
STATE OF FLORIDA,
COUNTY OF DADE.
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
therein by him s true..
Date 45 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commiuion Expires _.........» ._ ..._. »_
Member
Member _
Member . —
Date Disapproved
making corrections or changes to this application after approval has
when such re inspection is made necessary by improper notice for
Date
been obtained imam
inspection or faulty