144 NE 101 St (2)• MIAMI SHORES VILLAGE •
BUILDING INSPECTION DEPARTMENT
APPLICATION- FOR BUILDING . PERMIT
-- ---- -- Application is hereby-tnade for the approyal of the detailed statement of we 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,.Floricia.. and all provisions of the Laws of the State of Florida. all ordinances of- Miami- Shores Village and all rules
- --- .-regulations of thc.duilding Division. of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plane and specifications must be kept at building during progress of the work. . . • • •
• Date (.4re - 2 - / .19
Owner's Name- and Address i a ltd. t 57.-/ ‘- k "e- S _ .6 5 i/ aq•-■ a • fe-P ( str ,.___ZEj of
• Re Architect and/or Engineer —.... - . ----,...,--"-, tttt ......, „
7 ...........
Nsine and address of licensed contractor ?fr-et.... Tc- ZyfriPai..i-,..e rd. ,ZL.- 1,..A, ..-44 3 3_5"‘ 7
Location and legal-description of lot to be built on: .
- -Lot - Block. / - - Subdivision i 2?) g Li-X- M 1) /I 7- ' °6' ' /3 / flei
Street and Number where work is to be done._ _ 1 /.4 /V ./ 0 / f•-• 5
State work to be dole and purpose of building by floors)......../M- 1 -ies 11 . ..e..-/` -.P-........k-r-.
.... io . 15....avt.cl , ...1 o5 - yyrc............ j . _ia:h4...,...) iiac-k & c-/ kootli- I.._ 9 f.ei
Q:2154 2.0.-Cr geoc- 1-41 _repp....... i-afej 4).--1 (91-0 a) ' for no other purpose.
New Bui!ding Remodeling _ Addition Repairi . . No. of Stories
To be constructed of Kind of foundation -. - Ro
Estimated Total cost of improvements S........a-P9_ Amount of Permit
Zone cubage required —Plan Cubage —
Distance .to next nexrest building ------Siza of Building Lot
Maximum live load to be borne by each floor
STATE OF FLORIDA,
COUNTY OF DADE.
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 u ndersiencil applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
oi labor under the Florida Workmen's Compensation Act. being Section 5066, Compiled Ceneral Laws of Florida. Penrument
anti has complied %%id, th p rov i s i on s thereof, and will require similar compliance from all contractors or sub-contractors employed by him
in the work to be performed tinder this permit; and will post or cause to be posted for ins ection on the sit f the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ- only such su • actors. on to perfo ed under this
permit, as are licensed by Miami Shores Village. •
t (Signed)
5 76
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.. '4Q_ L_. Date I- - Read, Sworn to and Subscribed before me.
Disapproved .... .... i -...-.. Date — -
Notary Public. State of Florida
(Signed)
Building Inspector My Commission Expires.......—..........--
PLANNING BOARD - DATE
Chairman Member
Member Member —
Member Member
Council Approved Date Disapproved Date
() A charge of 31.00 will be made for making corrections or changes to this application after approval has }seen obtained finsts
the Plannii.;.: lloard.
A rc.isi•pection fee of 31.00 will be charged when such re is made. necessary by Improper notice for inspection or faulty
materials and/ oe workmanship.
/ STATE OF FLORIDA department of Professional in
CONSTRUCTION. INDUSTRY;
LICENSING BOARD
SCOTT.- WALTER:- WATSON.
INDIVIDUAL
CERTIFIED. GENERAL ?CONTRACTOR
•HAS PA! . TIIE FEE REQj;
FORT EAR EXPIR
D BY CHAPTER
3 .- 198 1 x;
SIGNATURE
PLEASE gEAO IM - P
131/OR
\ lra �y.�J INPO RM ATION ON REVERSE SECRETARY OF PROFESSIONAL
` REGULATION i -
`WA LLET CARD POL HERH•J
CONSTRUCTI : INDUSTRY :L ICENSING; BOARD.
POST:OFFICEBOX.2
JACKSONVILLE. -FL 32201
AUDIT CONTROL. NO. PILE NO. BATCH NO.
643036 C6C01857 00242
PEE AMOUNT
$80.00