1100 NE 99 St (10)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION rOR 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, herein specified or not. A eqpy of approved
plans and specifications must be kept at b g during progress of the work.
N Owner's Na e and iddress________ ., A '
------- _ .. 1.1...47.R..41.
A I 4 1
Registered Architect and/or Engineer_.
Name and address of licensed contractor_ .. 2_4_ .t: . L 4 L.,ker — ..7
Location ad legal description of lot to be built on:
Lot Block / 7 i ..h4.4:44.441:-
Street and Number where work is to be done__71*-4(
State work to be don- and purpose o building (by floors --0...5 . ...
? r le
and for no other purpose.
Remodeling _ Addition - Repairs No. of Stories-1 .... .., .
Kind of foundation_ tie.s4ett R Covering_eXtLea-t— -stegiaa--
Estimated Total cost of improvements $_.../.‘ .0....._____Amount of Permit $._ I
Zone cubage required ..2, a_...1.2012 __Plan Cubage_ 2.1.4.°
Size of Building Lot 1 90 ISA- 2
New Building
To be constructed of
be sent to he undersigned
_In • ' ,,,,,- ' ,;,? - . '''' :t ' ,' lar“,,,r0
or
. ' 4 4 1,1 •• • ... ' t, I . A • I., :
permit, as are licensed by hum Shores V I, -
'‘.
—
Disapprov
(Si
Buil mg Inspect
Date
Sworn to and Subsdribed before me.
PLANNING BOARD DATE
Chairman Member
Member ' Member
Member Member
Council Approved Date Disapproved
Distance to next nearest building
gi
Maximum live load to be borne by each floor_
I her _8
eby s mid1 the lans and sp,ecifications for saki building . notices with reference to the building and its construction may
( . 4 ...5 7 SI.
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, up n oath deposes and says that he is .............. ________________ _
of the above descr -d construction, that he fully read the foregoing application, and that he did sign the same, and that all facts
therein by him s e true.
Permit D ________
Notary Public, State of Florida
My Commission Expires.
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained
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.
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