960 NE 99 St (9)APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement ui toe 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, 1'lorid.i, 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 bc complied with, whether herein specified or not. A copy of Approved
plans and specifications must be kept at building during progress of the work.
Date .. 1:.
Owner's Name and Address itR ..:A Z �� 0 G ° U `j......._. No...l. Z S Street _ ..Sr.... 5 1: ..cA
Registered Architect and /or Engineer... 1.) E..2..C,2 is •1i .Z. �` I � .�•.
Name and address of licensed contractor ko.Qt.Ai.T_._.IS.- L.oct.l3Y
Location and legal description of lot to be built on:
Lot .S Block ?.° Subdivision ........I I... .t('• 1 ....__.
Street and Number where work is to be done 9 LLD LIZ ... i..S. al--
State work to be done and purpose of building (by floors) 1_..5 't"xi.•¢ 1 5..f Ai 4 f• _ I F4. t: LG. E.s........_.._.._._
New Building 1/ Remodeling
To be constructed of ... r.. . S • Kind of foundation
Estimate Total cost of improvements $ v x .000
1-
Distance to next nearest building. Z..t,
Maximum live load to be borne by each floor
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
and for no other purpose.
Addition Repairs No. of Stories
*.P..Q. 4a Cr— Roof Covering
Amount of Permit S. M' OQ
plan Cuhage
Size of Building Lot :0 le It to ... 3 ._. � I. CC !a.
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............ ?Va S.r. — lG....La03
The undersigned applicant for this building permit doesiercby 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, Permanent 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 sunder this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
pcnnit, 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 lie has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are e. � I
e Date 1.9.) l9
Permit No..
Disapproved ..
(Signed)
Date
Building Inspector
Read, Sworn to and Subscribed before me.
to me well known,
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Mcmbcr
Member .. ... Member ._.._
Council Approved Date Disapproved ............Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planniwg Board.
A re- impeetion fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection of faulty
materials anu /or workmanship.