1351 NE 101 St (4)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 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.
Remarks
Permit No.
Disapproved
(Signed)
Street and Number where work is to be done
The undersigned applicant for t
Compensation Act, being Sectio
compliance from all contractors
on the site of the work such pub
under this permit. as are licens=
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned
Chairman
Member
Member
Council Approved
99
NOTE: A charge of $25.00 wi
"Vex. \ 'v
State work to be done and purpose of building by floors). state exterior colors (submit samples)
Date
f
Date
Addition Repairs
(Signed)
Read, Sworn to and Subscribed before me.
Date -777-P 19` 4)
No./.Z2 StreetA/ � 0 � `•
Owner's Name and Address
Registered Architect andior Ergineer
Name and address of licensed contractor
Location and legal description if lot to be built on:
S. � ,// //. 9o9'O -
Lot v Block Subdivision
-R4 v 14 i7/ # � % ft . 3.3✓6
Notary Public. State of Florida
and for no other purpose.
No. of Stories
New Building Remodeling
To be constructed of � Kind of foundation Roof Covering
e
Estimated Total cost of improv ments S _ t/- Amount of Permit S
Zone cubage required Plan Cubage
Distance to next nearest buildi g Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all plans a d specifications for said building. All notices with reference to the building and its construction may be sent to
's building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's
5966. Compiled General Laws of Florida. Permanent Supplement. and has complied with the provisions thereof, and will require similar
r sub - contractors employed by him in the work to be performed under this permit: and will post or cause to be posted for inspection
'c notice or notices as are required by the Act. The undersigned ato em•loy only sucbcontrac n work to be performed
d by Miami Shores Village.
uthority, a notary public. duly 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 construct' n, 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.
uilding Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Date Disapproved Date
be made for making corrections or changes to this application after approval has been obtained from the Planning Board.
A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials anchor workmanship.