957 NE 99 St (2)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
Street and Number where work is to be done_
State work to be done and purpose of building
MIAMI SHORES VILLAGE
BUILDIN • INSPECTION DEPARTMEN
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the det, fled statenrem of the plans and specifications herewith submitted for the build-
ing or o h• :ructure her i described. This ri'licatic is made in compliance and con'o'm ty w•th the Building Ordinance of Mia ii
Shores Vi11ave, or da, and all pro. isions of the Laws cf the State of F krid. all o d nances ,,f Mi .ni Shores Village and all rules and
regu a ion, of the Building Div.. i of •ram Sho. illage 1- 'l ,e -o• ipl.ed with, whether herein specified or not. A copy of approved
plans and specificati •n must be kei" at building durin progress of tl.e work.
Date
Block.-_ ___. Subdivision
PLANNING BOARD DATE
Chairman ____ Member ..__ ....___ .
Member ____ __ _ _ ______ ___ __ _ Member
Member - Member
Council Approved .Date Disapproved -
s
Street.
I-.
' 4' and for no other purpose.
New Building. Remodeling._ _._. _ __. Addition____ ____ ___ _____ _ Repairs. _ _ No. of Stories.
To be constructed of. - Kind of foundation C_ _ .__. . Roof Co 'ring__
Estimated 1 :,tal cost of improvements $__. . . / 7 5.-- Amount of Permit $__ .
Zone ^ubage required_ __. __ ___ __... _.Plan Cubage
Distance to next nearest building_. .. _ _Size of Building Lot
Maximum live load to be borne by each f l o o r
hereby submit all the plans and specirications for said building. All notices with reference to the building and its construction may
be sent to
The Linde signed appli ant for.th's building permit does hereby certify eiat he understands and accepts his ,•bligations as an employer
of I bor under he Florida Workmen's Compensation Act being S• -tion 5988 Coi p led Gen al Laws of Florida P r anon. Supple vent,
and h s compl ed w th 'he prov':ions thereof, and will require s•milar comp lance from all contractors or subcontractors enrplo :ed by him
in the wo k to be p rt 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 not] e
or •otites as are requir d by the Act. The u. d. r ign.•d agrees to employ only such abconir. ctors, on woe to be perform -der this
permit as are licensed by M am. Shores N il:: ge.
Remarks__ - .. (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,.nd take acknowledgments, personally ap-
peared _. _- _.
.to me well known,
and who, being by me first d. ly sworn, upon oath deposes and says that he is the
of th abov de .c ibed • istruction t. : h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are i
Permit No. /2O _ ._. Date ___. Read, Sworn to and Subscribed before me.
Disapproved Date._
( Signed)
Building Inspector My Commission Expires.
Notary Public State of Florida
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application 'ftrr approval his been obtained from
the Planr ng Board
A re- inspection fee of $1.00 will be charged when such re- inspection is mu ie necessary by improper notice for inspe :•t'or or fa ity
materials and /or workmanship.