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925 NE 98 St (10)• Chainnan Member Member Council Approved MIAMI SHORES VILLAGE APPLICATION FOR BUILDING PERMIT Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the bulk, 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......1., ser Registered Architect and/or Engineer .._ Name and address of licensed contractor Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done State work to be done and purpose of building (by floors). New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ c Amount of Permit $ c. 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 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, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him 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 be 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 ..... .... _ 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 stated are true. Permit No 1 L ( Disapproved . (Signed) Date. Building Inspector NOTE: A charge of $1.00 will be made for the Planning Board. A re-inspection fee of 51.00 will be charged materials and/or workmanship. BUILDING INSPECTION DEPARTMENT Date._ PLA ING BOARD_ _Date Date__ 196, No. Street__4 and for no other purpose. to me well known, Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires. DATE Member Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re-inspection is made necessary by improper notice for inspection or faulty APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the det. sled statemen. of the plans and specifics. ions herewith submitted for the build- ing or o h. -ruc•ture her r described This t'1 licatic is made in compliance and con o'tn ty w th the Building Ordinance of Mia ii Shores Village, or da and all pro isions of the Laws c f the State cf Fh rid. all o d nances if Mi m Shores Village and all rules and regu a ion of the Building Div i of .ram Sho, iilage 1 '1 e •o. ip1 -ed with, whether herein specified or not. A copy of approved plans and specificati .m• must he kc at building durin progress of tl.e wcrk. Owner' Name and Address ...__ Registered Architect and /or Engineer Name nd address of licem.ed contractor Location and legal description of lot to be built on: :lot c Block r MIAMI SHORES VILLAGE BUILDIN INSPECTION DEPARTMEN Date Subdivision ` (Signed) Building Inspector My Com:nission Expires. PLANNING BOARD _ -- - ___DATE Chairman .. _._ Member :Member Member Member Member Council Approved Date Disapproved No.. r -• `f • C Street ,19 Street and Number where work is to be done. State work to be done and purpose of building (by floors) and for no other purpose. New Building _ __ _ Remodeling_ _ _ _ . _ _. Addition._ _ ... __ ... Repairs. _ No. of Stories To be constructed of _ Kind of foundation Roof Coy 'ring Estimated ' .tal cost of improvements $__ ,: r _ Amount c`. Permit $._ Zone ••ubage required -.. Plan Cubage..__. Distance to next nearest building .. _ _Size of Building Lot Maximum live load to he borne by each floor - - hereby submit all the plans and speciiications for said building. All notices with reference to the building and its construction may Li .=.cItt to .._ The unde signed appli ant for th s bulding permit does hereby certify that he understands and accepts his ..bligations as an employer of 1 bor under he Florida Workmen's Compensation Act being S 'lion 5966 Col p led Gen al Laws of Florida P r anon S mph cent. and h s compl ed w'th he prov' Irons thereof, and will require s•milar coma lance from all contractors or sub-contractors cmplo .ed by him ;n 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 noti e Jr ot'.c es as are regtur d ] 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 am. Shores N, it ge. ;Ian arks (Signed) STA I'E OE FLORIDA, (.OTJNTY OF DADE. J ss. Bctore me, the undersigned authority, a notary public, duly authorized to adn:_nister oaths ..nd take acknowledgments, personally op- -- to me well known, aid who, being by me first d ly rworn, upon oath depores and says that he is the of tl abov de -c ibed • ,struction t. • h has careially read the foregoing application, and that he did sign the same, and that all facts therein by him stated are ti ie. Permit No. _ _- Date __. Read, Sworn to and Subscribed before me. Disapproved ..__ . Date__ Notary Public State of Florida Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application 'her approval his been obtained from tic Planr ng Board A re-anspection fee of $1.00 will be charged when such re- inspection is r,.: a necessary by improper notice fur inspe tor or fa ity 1:uatcrials and /or workmanship.