1431 NE 101 St (5)MIAMI SHORES \VILLAGE
BUILDING INSPECTION DEPA�t
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 budding during progress of the work.
Owner's Name and Address .torso Rif % N f R f
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and lleFal description of lot to be built on:
Lot / T B B lock Subdivision 8
Street and Number where work is to be done 43/ Al.! �al s
State work to be done nd purpose of building (by floors)..
R.. o ..._ eoez4 9e
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of ouon Roof Coverin
Estimated Total cost of•improvements $ 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 submit all the p ins and specifications for said building. All notices with reference to the b 1 ing and its construction may
be sent to.... ierw o Ai •ice "
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 .r sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for spect•on on h. si of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such y ntrors, •n k •ttf be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed)
Disapproved _ _
(Signed) ��
Date.
Building Inspector
N9,o4
Chairman Member
\fernbcr Member
Member ...... Member ._._.
Council Approved Date Disapproved
Date . . aeC .. —_ / ._ _...._ _...
No..l ts/' st - eet..flit,'.'
8 4- c?...._ � 12 -.t..� .Cat �(.. —' -
goo my Zevelotioge cog
Notary Public, State of Florida
My Commission Expires
PL NINC BOARD DATE
/UV'
STATE OF FLORIDA,
COUNTY OF DADE. j 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.._... ! ? GP / Date 2c7 Read, Sworn to and Subscribed before me.
Date
has been obtained from
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning hoard.
A re fee of 31.00 will Ise charged when such re- inspection is made necessary by improper notice for inspection oe faulty
materials and /or workmanship.
4
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1431 N 103" St
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