103 NE 99 St (15)•
MIAMI SHORES VI LLAG E
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 Vi 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 T
Registered Architect and /or Engineer J1L PP d. - �' 1 7-
Name and address of licensed contractor____________ 1.6 �'C __
Location and legal description of lot to be built on:
Lot Block Subdivision
Remarks
Street and Number where work is to be done _____1 0. 3
State work to be done and purpose of building (by floors)_— ° t 4
Date !-`'i 1
No. /0 3 Street__ N e
New Building Remodeling Addition — Repairs -- No. of Stories 1
To be constructed of Kind of found ________ ; R nf ring sf 1- !� r -�
.
Estimated Total cost of improvements $____ Z ________ of Permit $ __±...,:„._ __ _
Zone cubage required__- ____ ________ _______ _______________- ________ ___ ______flan Cubage Z Z 6Cn
Distance to next nearest building Siz . uqing Lot
Maximum live load to be borne by each floor C -14.-.-. __ - f 7Y__ -!`
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 61- 0 - 0 - 7 - e-- 2- e dit -?•¢ '
Disappro d e__
Notary Public, State of Florida
(Signed) � k..■ Building Inspector My Commission Expires
PLANNJNG BOARD \ DATE
_ and for no other purpose.
•
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 5960, 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 suhcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
(Signed)`"_ _______
- -- - -- --- - - - - --
STATE OF FLORIDA,
COUNTY OF DADE. i ss
Before me, thee un. gned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared 1
— -- ---- --________ _ - - - -- - — to me well known,
and who, b-in; by me firs duly sworn, up n oath deposes and says that he is the • ,
of the abov escribed construction that he c ully read the foregoing application, and that he did sign the same, and that all facts
therein by 1 stated are i " _
Permit No. __ _ ___ _ Date 1 �� Jl bead, Sworn to and Subscribed before me.
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.
Pr
aPEUVriANymn
ataa'
r
1 _ 9_ 3
•
-LC
FRAN liATrON
f rO3N, er 99 -
GARA a , RA
Aft FATC: 81; V_ 5
943/4x_n_x_6_6_4 s.r (1_4 4,
1
10 / I
r _0(10__ te(d
114_4
ea 1 13
7 T-A---.6
•
N .
_< .. •.: 4 : fr,o VS CoA r.
.+All1 rrtot`It OI
U r:
t