1150 NE 100 St (2)5 - G 75
STATE OF FLORIDA, 1 .
COUNTY OF DADE. J s s'
Building Inspector
MIAMI SHORES VILLAGE
Owners Name and Address %
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where. work is to be done
Stag work to_be done and urpose of building (b floors)
Q
Application is hereby mode for the approval of the detailed statement ur ene plans and specifications herewith submitted for the build •
ing or other structure herein described. This application is made in compliance and conformity with the _ dinance of Miami
Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Mi ores Vi age a II rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether her specified or not. A_cupy approved
plans and specifications must be kept at building during progress of the work.
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
New Bui!ding Remodeling Addition
To be constructed of Kind of f undation
Estimated Total cost of improvements $ / O
Date.. ! > fi / t.. _»._. ..._.__..._... ,1 C�3
_ No .j/ 5 _.. Street.4. L.Q�t
II?
Read, Sworn w and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
and for no other purpose.
Repairs No. of Stories
Roof Covering
30 1X.
2-51 7,00
Amount of Permit t.
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 p 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 subcontractors employed by hint
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site oldie 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
pennit, as are licensed by Miami Shores Village.
Remarks... (Signed)
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 fads
therein by him stated are true. .
Permit No. P�9 Date �3
Disapproved _1.... Date
(Signed)
PLANNING BOARD DATE
Chainnan Member
Ucrnber 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 frrnn
the Plannir,g Board.
A re fee of 31.00 will be charged when such re- inspection
materials and /or workmanship.
is made necessary by improper notice for inspection or faulty