1301 NE 101 St (12)Owner's Name and Address
State work to be done and purpose of building (by floors)
AMI SHORES VILLAGE
UILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
JJ�� 11 /� � - ---• =— _ /' ,18
!.... at
...1� - � No,..�3.®!_ . Street! .a..i .. ./.D!
Registered Architect and /or Engineer .... .. J
Name and address of licensed contractor. .. ✓t �... Q • � s� e' f 1 • -- —
Location an legal description of lot to be built on:
Lot Block r2 --- - Subdivision....!....! ,\i9lfrn- -f �-./ � - �`=` -= �•• -. - --
Street and Number where work is to be done f' ) N � / s
--• - ••-
sl..s.'f -1
peared
Addition
21. .. ....1.11,1.11.. -2}2
and for no other purpose.
R? airs No. of Stories
New Building Remodeling
be constructed of...4� M- Kind of foundaTion r .... (AA Roo erin �J
1 37.A 4 "---" g
Estimated Total cost of improvements $ _O..1... ' J Amount of Permit Si. 1 Z
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 provisions thereof, and will require similar compliance from all contractors or sub - contractors 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 of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su � • ntractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signe .. _
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-
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.
Permit No. .__._. /9` 1 Date
Disapproved ...... Date
(Signed) .._ .�� N`'c a.7L
Building Inspector ° My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member 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
tlic Planning Board. •
A re- inspection fee of 81.00 will be charged when such re- inspection ix made necessary by improper notice for inspection at faulty
materials and /or workmanship.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
to me well known,
Registered Architect and /or Engineer
Name and address of licensed contractor... C. 10.4
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done ,L3..e
State work to be done and purpose of building (by floors)
Disapproved Date..
(Signed) `` �-a-
Bui ding Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
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.
Owner's Name and Address... .. . a'V.1 11 et......,f r....L td
Chairman
Member
Member ......
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re inspection fee of $1.00 will be charged
materials and/or workmanship.
New Building Remodeling Addition
To be constructed of Kind of foundation DO q ® sue
Estimated Total cost of improvements $.e2 r<
peared
.Set —2%! __..._.__ ....... ,19.7 V
... No /3 0 / street.LYF /
. a ,!,.... ,,..,,.y...,,, 111111..- .,...... y e
BALI I p
G.,2, .,) eYl.4.1.i.�� 5..,M..ay`-' pt-±1_0 ear fa-
and for no other purpose.
Repairs No. of Stories
Roof Covering
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 provisions thereof, and will require similar compliance from all contractors or sub - contractors 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 of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work j. performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed )Cr'
Notary Public, State of Florida
Commission Expires
PLA 1C BOARD DATE
V
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-
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 fpregoing application, and that he did sign the same, and that all facts
therein by him s ted are true.
No._ . �ue..
3 7 .Q Date....+ — - Read, Sworn to and Subscribed before me.
Member
Member
Member __.._.....
Disapproved Date
or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
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