1297 NE 100 StAPPLICATION FOR BUILDING PERMIT
Application is hereby wade 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.
Date. _........ ... �_..._._. ... 19.
Owner's Name and Address R/ eet..l.446 0.0 ff—C
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
Stet? work to be done and purpose of (b
.... . ....... .
New Building Remodeling
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Permit No...
Disapproved
(Signed)
Date
Date
But1ding Inspector
MIAMI SHORES VILLAGE
PL
BUILDING INSPECTION DEPARTMENT
To be constructed of Kind of foundation dizr
Estimated Total cost of improvements $ . = -; 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 f building. All not es with reference to the buildin and its construction may
be sent to._........,.?..L // �r..i�- . ar ` .s - ed. -�'.4 _e0 7 r - /� f!�'r ` c
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatrbn /as an emplo
al aws of Florida, ).e i
or sub- confraci.
he site of he
on w. k
41 1
of labor under the 'Florida Workmen s Compensation Act, being Section 5966, Compiled Gene
and has complied with the provisions thereof, and will require similar compliance from all
in the work to be performed under this permit; and will post or cause to be posted for in
or notices as are required by the Act. The undersigned agrees to employ only such su
pennit, as are licensed by Miami Shores Village.
Remarks.
Chairman
Nfcrr,ber
Member ...... _....__..._.�...._
Council Approved Date
Subdivision
�/ -S`'i�A" 1"
�.
floors ). l` � a� /.:�?_1..1..?�!�_
� �.�
and for no other purpose.
Addition Repairs .C7 So No. of Stories _
Rot Covering
Ov
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.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
-My Commission Expires _
NINC BOARD _.._......DATE
r
ent Supple' nt,
empl yed him
su . ublic notice
this
Member
Member _............__
Member .._ _..__...
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 Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.
1