1017 NE 95 StSTATE OF FLORIDA,
COUNTY OF DADE.
AFFU C
ss.
1
Disapproved
(Signed) ..
M AM El VO BLAM E
UILDING INS 'EC` RON DE.F` F21i'
TI ON FO N
,
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Subdivision_
F=3
UHL
Nev, 31.i:,':ag Remodeling Addition
To be constructed of Kind of foundation
Chairman .....
Member
Member Member
Council Approved Date Disapproved
ENT
PLANNING BOARD DATE
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.
/
Date._-- K / , fly
Owner's Name and Address No Street
Registered Architect and /or Engineer
Street and Number where work is to be done
State wcrk to be done and purpose of building (by floors)__:_ \. .'_
Repairs No. of Stories
Roof Cooing
and for no other purpose.
Estimated Total cost of improvements $ 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 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 to be performed under this
permit, as are licensed by Miami Shores Village. /
Remarks (Signed) e,
//y /
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 Date__ °" B__. Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
ng`Yns' ector ' My Commission Expires
Member
Member
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.
Date
has been obtained from
for inspection or faulty
DATE
O:-(v. :t 6-0431
COMMISSION! No.
I G3:.<3
J 140 104^
—1,
16°C FIELD BOOK 106 PAGE 68
_ SURVEY SKETCH No..-577
■
A SUhVEY OF
Lot 19, Emu the East of lot 18, Block 81, MItiNI MORES SECTION NO. 3, AccordInc; to te
treof recomeu in :217t Book 10 at page 37 of the Public Records of Daue County, Flo:A.
OLD A. SCH LER*.
LAND SURVEYOR
FOR
George `Lylo:- Ross
t
r -
1400V1 231 !31INSI_ Et Llic,
5804 SUNSET DRIVE
SOUTH M:AMI, FLORIDA
. • Setae . ;00 1
LocPtca 'a Mimi FIoreF,
LOT rK TCL
Scale 1" = 30
HEREBY CERTIFY, that the attached
sketch roprssenta a recent surve, 7:21i
under my dicection and .s ue cui cur
rect to the best '.3f
belief. There *.re ,;__
unless shown that-eel:
(
stared Land Survey° • No. .... . „„„
Stet* of Florida.