270 NE 100 St (13)Street and Number where work is to be done
Statz; IA?, an purpose of ding (by floors)
Council Approved
New Building '�� der
To be constructed of__ ...�
Estimated Total cost of improvements $
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
Name and address of licensed contractor
Location and 1e al d cription of lot to be built on:
Lot b3 /. Block 3 Subdivision
2� )/. C /
deling Addition
Kind of foundation
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 s it all ( plans , s 'fie ns for said buildin All notices with referen to th building and its constr
be sent to. ` i 7. c . g k4 f
The undersigned applicant for this building perinit 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 ormed /under this
permit, 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 co struction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are e.
Permit No 1 D Date ' � Read, Sworn to and Subscribed before me.
Disapproved J /f. Da
Notary Public, State of Florida
(Signed)
wilding Inspe .r My Commission Expires
E ANNING BOARD DATE
Chairman
Member
Member
Date
will be made for making
Date
No.._ __ 7 0 Street.
and for no other purpose.
Repairs No. of No. of Stor i
B. of Covering
ri a �®
22- (019
/do
Member
Member
Member
Disapproved Date
corrections or changes to this application after approval has been obtained from
NOTE: A charge of $1.00
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 or faulty
materials and /or workmanship.
•
C EAV/EW INDUSTRIES INC.
3375 W. VV. 25 T " S
M I A M I , FLOR /DA
NAME
2( )/:
ADDRESS
MuN I C I PA L I T Y
-
Jo B .A/o.
LEGAL DESCR IPTION
L oT 3 T
BLOCK 33
S uB DI V lS ioN
C0.57 of ToB
FEE