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1210 NE 100 St (4)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. ((�� nn 't ' Date ` �/ 19.`l_ &"s ' N . - - _ y � =; n Owner's Name and Address Registered Architect and /or Engineer Name and address of licensed contractor -r- Location and legal description of lot to be built on: Lot l Block Street and Number where work is to be done State work to be done and purpose of building (by floors MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Disapproved Date (limed) Building Inspector Subdivision _ =___ Remodeling Additi -- New Building _ -- 9 _ , To be constructed oPc4.4 /i :_ Kind of foundation Vii =_b Estimated Total cost of improvements ` p $____ 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 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 rovisions 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 i s ection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subc tractors, o /work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed / /��� 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 hill s ted are Permit No Dat Read, Sworn to and Subscribed before me. No Street and for no other purpose. No. of Stories Roof Covering '� ,. � ... Repairs Se Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member IA ember 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.