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935 NE 99 St (8)8,00 Street and Number where work is to be done ..... Chafr nan Member Member .... .... Council Approved '1IAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT (Signed). ANNING BOARD_. _. DATE Member Member Member I)ate Disapproved .. 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 building during progress of the work. • j� Date -! /6 , 19. / ner O w ' s Name and Address . � e NO 9 _ . Street�l - .9�7 Regftered Architect and /or Engineer . . . . .. _.__ . Name and address of licensed contractor. 6?'' (/ e, . a,2 . �� �‘,.., 2 Location and legal description of lot to be built on: '�`" Lot._ Block . Subdivision ............. State rk to done and purpose of building (by floors)._ and for no other u p rpose. New Building ___ Remodeling . __.. Addition ._ .. Repairs No. of Stories To be constructed of Kind of foundation... Roof Covering_.. Estimated Total cost of improvements $ 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 foe said building. All notices with reference to the building and its construction may be sent to.... _ _....__ The undersigned applicant for this building permit dot 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, Peruianent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractor 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 worly to be r mid under this permit, 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 a.l:nowledgments, 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 lie 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 .111 7 "2 Date - _ Read, Sworn to and Subscribed before me. Disapproved _. „ ... . Da Notary Public, State of Florida (Signed) m ding lnspe fr My Commission Expires...- .... Date NOTE: A charge of $1.00 will he• necule for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.011 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty - materials and /or workmanship.