990 NE 100 StMIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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 herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Registered Architect and /or Engineer " ✓
CI ,,. ,
�� /� QQ
Name and address of licensed contractor......J Q s.,l.,Q .0.8 A',. , s .._/.,1 Awc.0....e M C Gy
Location and legal description of lot to be built on:
Lot Block Subdiv ssiioon.
Street and Number where work is to be done 9 .l`-.r a
State work to be done and purpose of building (by floors)
To be constructed of Kind of foundation
Estimated Total cost of improvements $
(Signed)
Date.._
Chairman
Mfcrr,ber
Member
Council Approved
PLA NC BOARD _.._......DATE
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
• A re-inspection fee of $1.00 will be charged
materials and /or workmanship.
Member
Member
Member
Date Disapproved
��yy
, 19..
sass
No..l.f . ! sa ss . S 6
Date..._..._..
oogo
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
Amount of Permit $.
Zone cubage required Plan Cubage
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 pennit 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 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 insp ion on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcory cto n work je -fie performed under this
permit, 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 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 3 7 Date ° 7 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Buildin nspector My Commission Expires _
or changes to this application after approval
to me well known,
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
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 herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Lot
U
New Building
To be constructed of
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Block
MIAMI SHORES VILLAGE
Registered Architect and /or Engineer ' -
State work to be done and purpose of building (by floors)
Name and address of licensed contractor � y1%2 { t >"-
Location and legal description of lot to be built on: 1'
/O
Date
19_—_
No. Street_ 4 a
ubdivisio
S
Street and Number where work is to be done 9 6 ( Q 0 . t
rtA
L4 IJ. ? <J
Remodeling Addition Repairs No. of Stories
Kind of foundat Roof Covering__
PP�� o
Estimated Total. cost of improvements $ � o ' Amount of Permit $ S
Zone cubage required
Distance to next nearest building Size of Building Lot
Maximum live Load to be borne by each floor
.Plan Cubage
I hereby sub it all the plans and s 7 ificatio n s for said building. All notices with reference to the building and its construction may
be sent to J�,�- - =r`- B21`,/r_� — — �'.f / /( - , `S-
The undersigned applicant for this build 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 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 subcontractors, on work o be i5erforpied under this
permit, as are licensed by Miami Shores Village. t ��
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
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 C
Disapproved
(Signed)
Date_ ___ /i � Read, Sworn to and Subscribed before me.
Date
Notary Public, State of Florida
uilding nspector My Commission Expires
and for no other purpose.
PLANNING BOARD __DATE
Chairman Member
Member Member
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 Planning Board.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.