990 NE 99 St (3)Owner's Name and d dd
res s'
Permit No. /5
MIAMI SHORES VILLAGE d 43
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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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 here' specified or not. A copy of approved
plans and specifications must a' building during progress of the work.
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Registered Architect and /of Engineer 2P-f-/X/
Name and address of licensed contractor
Location and legal d scription of lot to be built on:
Lot /��� �� Block Subdivision._ -
Street and N er where work is to be done .9
Date
N
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and/or workmanship.
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Street
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State work to be done and purpose of building (by floors)
:,, ' and for no otherr purpose.
New Building Remodeling Addition Repairs No. o St es. O
To be constructed of. a -S L. Kind of foundation Roof Covering..
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Estimated Total cost of improvements $ 1.e?,..0 , Amount of Permit $
Zone cubage required .Plan Cubage 7 -' 1 4
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 s - ' icatio s for said building. All notices with reference to the building and its construction may
be sent to / . ® /l-f_. ......... . OJ ,,-04a20 e;
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, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance fro i . ontractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be post - . " or i pec "on on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su h sub ontra tors, on work„ to l Y'bbrformed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signe •
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, 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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Date 4 - 4 - `I Read, Sworn to and Subscribed before me.
Disapproved �j Date
(Signed) _
lding Inspector My Commission Expires
Date
has been obtained from
for inspection or faulty
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