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103 NE 99 St (2)Name and address of licensed contractor MIAMI 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 prpgress of the work. Date......_... /..L._.._..._ . _..._._._. ,19. 72 Owner's Name and Address From � �� r•rr'.. "� �._.._ .� No. 1 el . . Street._.�C 7J 'f Registered Architect and /or Engineer C al'r' ` /;11 Location and legal description of lot to be built on: Lot Block / Subdivision Street and Number where work is to be done... O.? ,F ?( . f ✓ i7//a/77( f�e� P • __sass �..._ State work to be done and purpose of b iin (by floors) Prne6� J c7 / l ao Ar et pun ld y g (y ) G - -.. ... - (ie■ ..._...1Fo( Dpi^ ger h .t' P Gt ri Disapproved _ .. /.. Date (Signed) u P CA/ 7/ r , �(i /Y; G CL/77 r Building Inspector ∎A PI Pt oho and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of 01 '^x— Kind•of foundation Roof Covering sass. p . 11 ' " S— 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 suit / all l the plans and / specifications for said building. All ites with reference to t e building and its construction may / be sent to tJ ea V c .4,— -Lii g v.S'Th of ,1r 7Y /J T f(6"--%:(7 ; Q'm / ( .�.2/1., 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 u • • ntractors, op work g . . perf ed under this pennit, as are licensed by Miami Shores Village. Remarks (Signed).. Notary Public, State of Florida My Commission Expires 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 e. Permit No.______ r v y Date l� L _- Read, Sworn to and Subscribed before me. PL INC BOARD DATE Chairman Member Member Member Member sass... ___._._..__._ ._.._ 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 anti /or workmanship. i I APPLICATION 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. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Registered Architect and /or Engineer i GN Name and address of licensed contractor.._. ?Jt'' a !!e a Location and legal description of lot to be built on: Lot Block Subdivision Street and Niunber where work is to be done State work to be done and purpose of building (by floors) /4"F' New Building Remodeling 4-r" Addition Repairs No. of Stones To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ 5 _f�..o._�� Amount of Permit $ Zone cubage required Plan Cubage 14'c Distance to next nearest building. Size of Buildir*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 ender 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) STATE OF FLORIDA, COUNTY OF DADE. j Disapproved . ___ - .__ (Signed) 7( Building Insp tor Date • r Date _.. r d i Date .11 (O , 19 No Street and for no other purpose. 12-17 2 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: 1 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 //- Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman 7 Member Member Member Member __ Member Council Approved Date Disapproved Date TE: 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 inspection fee of 81.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty makers Is and /or workmanship. J 42 -1 Q__• 31 -0 FY .c 7 2 I ( o • IA- 001 a 1 a "w " � G . `k- t E" Le ArL1.,mil J e —704_ /03 E T 7 5 1