1285 NE 101 St (5)b
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or crre plans and specifications herewith submitted for the build •
in 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 progreu of the work. /�
Dates 1... r _ _ 19
Owner's Name and Address ...... r�� l4,y/ _ ._ No... . �.. . ..... Str IPLSL
Buil•ing Inspector
PLANNING BOARD
Chair ;nan
Member
\icmber .. .. _ _....__....._._._.�...._.......
Council Approved Date
DATE
Member
Member
Member —
Disapproved
Registered Architect and /or Engineer /
Name and address of licensed contractor... , /1��..��/1!f. g
Location and legal description of lot to be built on: ed
Lot Block u ►visio
Street and Number where work is to be done... t.. 1 r ' r t . �
State work to be done and purpose of building (by floors). ll. .. lt`r /d[11 .[KGL..._
Notary Public, State of Florida
My Commission Expires ...
or changes to this application after approval
NOTE: A charge of $1.00 will be made for making corrections
the I'Lrnnir.g hoard.
A re—inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
and for no other purpose.
Addition Repairs No. of Stories _
Ncw Bui!ding Remodeling
To be constructed of Kind fountion )roof Covering
Estimated Total cost of improvements $ Amount of Permit $. ..�� j v , �' ►J f
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 sub ll e la s and s cifications for said building. All notices with reference to the building and its construction may
e sent to.. . ..� i Die
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 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 - the site of the ork such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcgntrgct. s, . work to . performed under this
pcnnit, as are licensed by Miami 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 careful y read the foregoing application, and that he did sign the same, and that all facts
k) l Read, Sworn to and Subscribed before me.
thcrcin by him stated are true.
Date
D e.._.. _
Date
has been obtained from
for inspection or faulty
blE
s.fT
CHASTAIN FENCE COMPANY, INC.
901 N. W. 143RD STREET
• MIAMI, FLORIDA 33168 • PHONE 688 -0541
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13u.CLdezi of 13ettez Cjenee
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CHASTAIN FENCE COMPANY, INC.
901 N. W. 143Rd STREET
fir
• MIAMI, FLORIDA 33168 • PHONE 688 -0541
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23uiLcders of 2ettet Cjenee
h .B - wall
,Village of Miami Shores
JOB 111111 o F n-i a .i
ADDRESS 1? is 4 /) •
INSPECTION a -
TIME READY -' L 4(f f 3 - 7 --3Z-
REMARKS
ct%2
N? 3884
INSPECTOR DATE 7�'�}
.`Pillage of Miami Shores N° 3817
JOB
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ADDRESS / Z S /0-6 /
INSPECTION Pt - r / F ere_ ' -
TIME READY
REMARKS
INSPECTOR
DATE 7 " S'Te,