1350 NE 101 St (17)Permit No
Disapproved
(Si
Estimated Total cost of improvements $
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
Ch l' .•:n
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.
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__:!_
Registered Architect and /or Engineer 4___ /_44
Name and address of licensed contractor F=
Location_ , nd legal description of lot to be built on f/
e :
Lot_ Block ��Y ° /9„ Subdivision
Street and umber where work is to be done ij tact '
State work t be done and pu ose of building (by floors)
,
Date_
Z7
,
•
B • i . mg nspector
�f.
New Building Remodeling Addition
To be constructed of Kind of foundation
Date /X2/ 7
No
// e 11- fir/ r 1,12
and for no other purpose.
Roof Covering
PLANNING BOARD DATE
Street
1 611, Sworn to and Subscribed before me.
,19 S '
Repairs No. of Stories
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.
Remarks (Signed) . <'G2 . � • t.�G' >s�2 /� j / e.
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, bein:.y me first duly sworn, upon oath deposes and says that he is the_
of the above . escribed nstruction, that he has carefully read the fo ing application, and that he did sign the same, and that all facts
therein by him
Notary Public, State of Florida
My Commission Expires
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