967 NE 99 St (3)Street and Number where work is to be done
Disapproved
(Signed)
Building Inspector
NOTE: A charge of $1.00 will be made for
the Plannir.. I:u.ud.
A re.ni'p ction fee of 51.00 will be charged
materials anti /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the appro\al of the detailed statement or ene plans and specifications herewith submitted for the build •
in 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 Divisinn of Miami Shores Village shall be complied with, whether herein specUied or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Namc and Address M / 4e 1.�° e
Registered Architect and /or Engineer..... .s.S. • 77/.2 t1
Name and address of licensed contractor M a Q-4.CW .i
Location and legal description of lot to be built on:
Lot.Y cs 21 / Z 2 - Block 170 Subdivision SC2 C-
State work / to be done andyurpose of byild' g (by floors) .$2.02.4
4,a.,�i ��si... ......ct. Id( . P . Al , ......... - - -_
peared
Date
Chairnan
M1crraber
Member .. _.....__....._..._.�...._
Council Approved Date
Date..._
.s c 4
PLANNING BOARD DATE
No.... »� .�.._... Street_.eve _2. i 4-
and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundatia 7. Roof Covering
p . . fg of Permit $. 416,53
Plan Cubage
Estimated Total cost of improvements
Zone cubage required
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,
anti 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 subcontra ors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks... _- ._..__ (Signed)
'1
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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 e � stated � are true.
^ .
Permit No.._. ^'Y 1. Date 11/ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commiuion Expires _ _ ».._..... _ .—
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
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