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171 NE 100 St (10)STATE OF FLORIDA, COUNTY OF DADE. appeared Disapproved __________________ Date (Signed) — — — — — -- 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 building 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 regula- tions 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_ — (2 19' �- ------------------ Street_L/ �' Owner's Name and Address__ Registered Architect and/or( Engineer Name and address of 4i4Wilisell.contractor Location and legal description of lot to be Wit on: - Lot � 4 f%d � �'f����Block �'�� Subdivision % Street and Number where work is to be done / / / (:# State work to be done and purpose of building (by floors) 1 9 I 1� _rl N r - . �'f� r =� l� f � r ; + e r I e:_aL- .'r, ll ! ;tip'_.} ¢.; -2- 6 ,7) 4 e C ! .sr ' . for for no other purpose. New Building Remodeling__ 'Addition X_ Repairs No. of Stories_______________ To be constructed of_____—____ —_ Kind of foundation L ''''x ,Roof Covering__ —_ Estimated Total cost of improvements $ , ,r�t `? U 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 him 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 subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ?7 A4 Remarks (Signed) x� Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 a rue. Permit No. ! Date D / Read, Sworn to and Subscribed before me. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member _ Member Member — Member Member Council Approved_ Date Disapproved to me well known, Notary Public, State of Florida 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. r ..... .. • t ■•4 '....... ......: , . : n;_':,;,.-i,;:jiit:;ti...-_,,.....a.._._ SPEC! FY FLORIDA CEMENT Owner's Name and Address 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 building 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 regula- tions 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. z Registered Architect and /o • gineer .: ,z� Name and address of aiiiidossh contractor Location and legal description of lot to be bit on: o a Lot_A ® a l t " �j?& /Block_ 14) Subdivision - e --- , 4 :1-- Street and Number where work is to be done 111 State work to be done and purpose of building (by floors) rE - ?/ r-1 .QtL AERALr 2 —T N-- .2115 .___P.6.-Lelfe&AL__Cd_k_e-ei-k7 / New Building_______________________ Remodeling_____________ Addition _ ___ Date_ — , 19 Street1J AI __ P44 7F4 17 and for no other purpose. No. of Stories____ —� To be constructed of Kind of foundation C 4117____ Q_ 4_0-kRoof Covering 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 for said building. All notices with reference to the building and its construction be sent to Repairs may 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 on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) i STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the u de igned authority, a n@tary� my authorized to administer oaths and take acknowledgments, personally appeared 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. Permit No. g 7 __ Date Disapproved _________ Date (Signed) Notary • ublic, State Flo Notary - a ?C. a-0LF - My Commission Lxpttr �3l : . rrmr expir Sept. can s of p a o y5. PLANNING BOARD DAT ` Member er Member M r Council Approved Date Disapproved Chairman Member Building Inspector ____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 materials and/or workmanship. notice for inspection or faulty