1351 NE 101 StNew Building
To be constructed of
Estimated Total cost of i
Zone cubage required
Distance to next nearest
Maximum live load to b
I hereby submit all
be sent to.. 4 ° .... I
Remarks
STATE OF FLORIDA,
COUNTY OF DADE.
and who, being by me f
of the above described
therein by him t
Permit No
Disapproved __
(Signed)
Chairman
\lccr,bcr
Member ..
Council Approved
NOTE: A c•h.rrge
the P1,uinir,;; Board.
A rc•impection (ce
materials and /or workm
building
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereh) made for the approval of the detailed statement ur me plans and specifications herewith submitted for the build •
inc or other structure hcrlein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida. a rd 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 n ust be kept at building during progress of the work.
Date..._ — / — ,197!
O.vncr's Name and Addr ss
pp o.vF..�' . — No / Street-1 S. f _ :....\SST.!QFt 7'
/�.
Registered Architect and or Engineer ... A..Q. F/?T s i / 3 .? or NSF. /6 . . N. M # ay3O
Name and address of lic nsed contactor 5>r:1Y19..E.F...Cer .. Cog?. .T'i c. �/�UP1` ;2 .
Location and legal descri tion of lot to be built on:
Lot 3 Block r Subdivision s!4 _ 4' S.TAL..T. Y
Street and Number wher work is to be done /.$ s..f AC.: ....1..o./..._.S fr _.._..__
State work to be done a d purpose of building (by floors) 4A,2.J Tic 41 _r' £&. /Sr /tisr- R.212 01 /4 X.rg7e-_.._..._
Nc A E I g dclin g Addition
Cca/cRE TE
Amount of Permit S. 1 1
Lot— e Kind of foundation
z 00
provements $ 000
borne by each floor
e plans and specifications for said building. All notices with reference to the building and its construction may
11Ft.R.R0 -y tP C,Ic/ €&Pf/ /IL f1/9. ? /. ..�t
The undersigned ap licant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Flon a Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sop clement,
and has complied s ith t e provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in
the work to be perfor ncd 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 require by the Act. The undersigned agrees to employ only such subcontraStors, on w 'k to be . rformed under this
pcnnit, as are licensed b Miami Shores Village.
Before me, the and rsigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
rst duly sworn, upon oath deposes and says that he is the.
onstruction, that he has carefully read the foregoing application, and that he did sign the same, a nd that all facts
true.
Date 2 4 - )17 Read, Sworn to and Subscribed before me.
1 Date
(Signed)..
Notary Public, State of Florida
-i-
-3 1%) t
WO' ,&y-,1
and for no other purpose.
Repairs No. of Stories
Roof
Covering fl19T /l.T...C/,f�__
.Plan Cubage
Size of Building Lot /03 • 67 _
to me well known,
Building Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member _.._.....
Date Disapproved Date
f $1.00 will be made for making corrections or changes to this application after approval has been obtained from
of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
nship.