1100 NE 99 St (13)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building _
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Value of
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Architect
Contractor
or Builder
Legal
Description
Lot II 11
Address of
Buildin "f
This permit is granted to the contractor or hakes'
tion herefor in strict compliance with all ordinances per
plans, drawings, statements or specifications that tray
at any time if the work is not done in compliance with
permit is granted is the uttderstanding that
regulations pertaining to the vtotqf covered he
sibility for work dene by his agents, servants or
in consideration of the issuance to me 4
pertaining thereto and in strict conformity with thri
cepting this permit I assume responsibility for at want:
CONTRACTOR OR BUILDER
MIAMI ! _
N9 74
Betook above to
veto sad
hazy! submitted io tied approved
attiliisoneas or pities ue dates
Lei ' ir!a soosfass the
or ilhavriago se Y
time* ale
remit
quote to whoa the work covered hereunder in
q, etatosto tto or -:. tfope eztbit3l;ted to the .
110 bP tither, sty- t, servant or employee,
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Work to b.
ontractois
Lime No. / �- •.
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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 j �
Name and address of licensed contractor !i_! 71 _ , e �._1
Location and legal description of lot to be built on:
STATE OF FLORIDA,
COUNTY OF DADE. ss
Disapproved
( Signed)
MIAMI SHORES
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date _V _ ,t ` e / , 19
Ca- ici . _fl_- - -, - No.)) C Q Street 1) 97 5] -
CCroe -
d ALe)
/6,107 P.E. _ /3Ave.
Bea c2
Lot_ —_____ Block Subdivision
Street and Number where work is to be done ./l 0 0 P L. ?.Q .S'Y '
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories 0 A h.
To be constructed of Kind of foundation_____ of Covering
Estimated Total cost of improvements $ /).-0 C Amount of Permit $ 7
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 5988, 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 work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks — - - (Signed) 41
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 TO - 9 Date Read, Sworn to and Subscribed before me.
Date
Notary Public, State of Florida
Building Inspector My Commission Expires
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 imprc,wr 1 ,iire for inspection or faulty
materials and /or workmanship.
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