34 NE 101 StMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement ur the plans and specifications herewith submitted for the build •
inc or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. and nil 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.
Date..._..._..._ _......4 .� _..._ . . ,18.1_
` . N. ,.2 — No.... .. ...... str eet.A r3t7
Owner's Name and Addres...........,1.,0...r��. ,�� +�.»....
Registered Architect and /or Engineer .. :.. .,.•• ..... ....»Rl....•f
Name and address of licensed contractor _.__.
Locat' n and legal description of lot to be built on:
Lott, . ` b Block / 0 Subdivision i.A ti $. .2eira
Street and Number where work is to be done 3f A e_ ot'._.4'f ..._.._..... _.._ _._. ...__
State work to be done and purpose of building (by floors)....._.ed..l�Q �._ ....2 il ,..... _._...i> g_..
and for no other purpose.
New Building Remodeling Addition A' Repairs No. of Stories
To be constructed of ...i 00 Kind of foundation oof Covering d0 . ................_..__
p
Estimated Total cost of improvements S 5D Amount of Permit S.
Zone cubage required .Plan Cubage
Distance .to next ne.uest 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 previsions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
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 arc required by the Act. The undersigned agrees to employ only such subspntractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remuks (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
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.
Permit No.. 90 Date 0 LJ 4 .......... ..._ Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Building Inspector
Notary Public, State of Florida
My Commission Expires _...._..._. _ . _
PLANNING BOARD DATE
Chair :ran Member
Member Member
Member .. .. Member ...._ —
Council Approved Date Disapproved Date
NU T E: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the I'I.inning Board.
A re-inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anti /or workmanship.