1247 NE 101 St (9)Application is hereby uinde for the approval of the detailed statvilienu or me plans and specifications herewith submitted for the build •
inc or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shi;res Village, bk rid.i. 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
plus and specifications must be kept at building during progress of the work.
Owner's Name and Address . -
Registered Architect and /or Engineer
Name and address of licensed contractor
be sent to
Disapproved >��1. tj �..� _...... Date
(Signed)
APPLICATION FOR BUILDING PERMIT
Building Inspector
Chairman
Nfcrr,ber
,tember ..
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
PC _
State work to be done and purpose of building (by floors)
PLANNING BOARD DATE
e.
Date..._ ! id .cIi _1!_...._. ,19..E
No. . /.04/.7 ._... Street_( . /0 ...
Location and egal description of lot to be bu ilt on:
Lot Block /M5' ,� //
Street and Number where work is to be done ./ 2 !t/'E• 11,i ..
Subdivision. 3,4.Y d ie.
e. ..zd:.
i2J.29 / PA/ O F
_.._. and for no other purpose.
New Building //s�� Remodeling Addition 4 Repairs No. of Stories / _
To be constructed ofeaelleR.E. Kind of foundation .(1 .4A.C./.41 Roof Covering... A24.47
Estimated Total cost of improvements S... QO V42 Amount of Permit Si.
Zone cubage required .Plan Cubage OO
Distance to next nearest building a2 6
Size of Building Lot.. A /it) Maximum live load to be borne by each floor
I hereby su all the p)zn and specifications for said building. All notices with reference to the building and its construction may
Member
Member
Member
.... fii ,00TT
./4 f. V, != . /0/ P. % / 'PM" e.ch'n sQ S
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 Sup )lenient,
and has complied skitlr 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 th the work such ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such su tractors, o 'o be performed under this
permit, as are licensed by Ntiami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. J 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 true.
t
Permit No •"� o i Date.. . II? Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
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 hecn obtained from
the I'Lrnnir,;; Board.
A re inspection fee of $1.00 will be charged when such re inspection is made necessary by Improper notice for inspection of faulty
materials and /or workmanship.