187 NE 100 St (12)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approyal 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.
State work to be done and purpose of building (by floors)
Date...
Owner's Name and Address
R egistered Architect and /or Engineer ...... .............. ...<....,..,, ,,.I,_„
Name and address of licensed contractor. C.:4- D 8 A ._... d M/�..I.QQ /
Location and legal description of lot to be built on:
Lot Block / Subdivision
Street and Number where work is to be done
'..s./.f14 4-7 - P2' E
N o
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Cove
Estimated Total cost of improvements $ 3d C> ? A>Inount of Permit Si. A_ o
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 a
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 arc required by the Act. The undersigned agrees to employ only such subcontr• orson work to performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed).
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-
peared
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 s e are true
Z / 5L
Permit No.._ ___ Date 2 - 7 , Swor to and Subscribed before me.
Disapproved _ _ 7 .. . Date
(Signed) _.__ Notary Public, State of Florida
._
Builds g Inspector My Commission Expires
PL NNINC BOARD DATE
Chairman Member
.lerhber 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 hecn 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 oe faulty
materials and /or workmanship.
U us l;
w i\/
16-- NE
STATE OF FLORIDA,
COUNTY OF DADE. ss
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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. ( 4 V K &Selig N ... No...) 27 ............. Street... tr• /OO r
Registered Architect and /or Engineer
Name and address of licensed contractor ...NQ.Qjj.....C.QNSt?.R ✓ 4 r/.4 t`' COAL. CV W. P ► lc/ F ,444 Y.
Location and legal description of lot to be built on:
Lot
Block 1 S Subdivision..M.!.a.M! ... c • T P 8 / %D
Street and Number where work is to be done.... E • sT _
State work to be done and purpose of building (by floors) l f...P4 !1e_ SeCT.tak 'E.... IN4.Tb«.._ Ress
SL f,QpN. ...QQ.Q.R.S.... 4.440..rTR.y.c T W AAL it.wAY d. STEP s
and for no other purpose.
New Building Remodeling >( Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 7 0.0 Amount of Permit $
Zone cubage required plan Cubage
Distance to next nearest building Size of Building Lot SQ
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..NO09 . - -C4:10 0 7gUC.TiPA1 COR1': /s7S1 W D t. k !t.:.- lafcoY..... ma, - .of /IfM. t- ..Se.9cAv
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) %��r'!r!
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me
of the above described
therein by him sIa(d
Permit No...
Disapproved
(Signed)
first duly sworn, uport oath deposes and says that he is the.
construction, that he has carefully read the foregoipg-application, and that he did sign the same, and that all facts
�'
Date ./ P t" `_ Read, Sworn to and Subscribed before me.
Date_:_. r --••
Building Inspector
Chainr an
Mcrrlbcr
Member .. �....-
Council Approved Date
Notary Public, State of Florida
My Commission Expires
PLANWIG BOARD DATE
1.17,.,,, - 11 .,., :.<... ,,
to me well known,
Member
Member
Member �_._ ...
Disapproved Date
NOTE: A ch.irge 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 51.00 will be charged when such re- inspection is made necessary by improper notice for inspectitm oe faulty
materials and /or workmanship.
aiami cihorenfillage
F L 0 R 1 D A
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 .....
.y.>,Q,�L,t.
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
Street and Number where. work is to be done
State work to be done and purpose of building
D A -
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of.. Kind of foundation Roof Covering
Estimated Total cost of improvements $ 00 Amount of Permit $.
_Plan Cubage
Size of Building Lot
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
- I here submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sen 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
perinit, as are licensed by Miami Shores Village.
Re:narks (Signed) .emu. s a�rcv2
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-
peared
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.__.._ 7 � �_ _ D ate Read, Sworn to and Subscribed before me.
Disapproved z /Date. _a
(Signed)
MIAMI SHORES VILLAGE
Building Inspector'
Date..._
.,........ _ No..` 1 Str eet
QtyN
Subdivision
1 b1._...N�
(by floors) __....[....... s--....\.-4? . A V� R ? ...._...._.._._
Notary Public, State of Florida
to me well known,
My Commission Expires
Pi✓ANNING BOARD DATE
Cnairnnan Member
Member Member
M ember - - -- - --
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
the Planning hoard.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection of faulty
materials and/or workmanship.
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