253 NE 100 St (2)Remarks__-_ (Signed)
Disapproved Date
( Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made fo e 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 alVrovisions 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.
Date July - - - -1, ,19__66
Owner's Name and Address 253__.N_.___L.____ LOP __ .tree No. 253 Street 100 Street
Registered Architect and /or Engineer
Name and address of licensed contractor Truly Nolen, Inc. - 600 N. W . 7 Avenue, Miami, Fla.
Location and legal description of lot to be built on:
Lot—___ Block Subdivision
Street and Number where work is to be done 251 100 ___Str e ,___Miall►i___Shore$ Fla.
State work to be done and purpose of building (by floors )______- F?UIn1g&t.] QA - Ua -ng__Vikanegas w it h a n
._____appr_oxi.mate___2Q ___hours- ._expaslire___p r Qd. Nylon tent.
- EXTEIZMINATIDN and for no other purpose.
New Building Remodeling Addit}on Repairs No. of Stories
To be constructed of Kind of foundation CBS Roof Covering Rip Tile
Estimated Total cost of improvements $__25.3_.00 Amount of Permit $ __5.00
Zone cubage required_____ Plan Cubage 24,544
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 dogs hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5968, 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 th ite of the work such .ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wo tg- a performe der this
permit, as are licensed by Miami Shores Village.
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 stated are true.
Permit No ,r 6 9.' Date Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member 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 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 n.;tice for inspection or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of //
Building /-
Legal Lot
Description
MIAMI SHORES VILLAGE, FLORIDA /
DATE 7 _ 19—.,2
° PERMIT N9 7694 Contractor's c
° License No. o + 35
D
Architect
Contractor "`'�, � ` �L / ,
or Builder f `� ! y
CONTRACTOR OR BUILDER
B1
Work to be performed under this Permit
1
tt ; :;41
�
-c—
Subdi-
vision
Address of ��p`" Value of I Amount of , — e>t,
Building 3 G' -�4f Project $ 3 1 Permit $ ="
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed. lv :4 e.1 1 . G� �
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in reliance with all o and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY
NSPECTOR