290 NE 100 St (8)Application is hereby mane for the approval of the detailed statement of the plans and specifications herewith submitted for the build ''
ins 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 iuilding 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..
J'VL 2 8 i977
Date.
•-�- G . —
.
Ownc.'s Name and Address' LQ ,.L„ .__) LEN \ C 6 ' _- No. &SS;,..,L $reef
Registered Architect and /or Engineer.. t. 1
Tame and address of licensed contractor 3C)
Location and legal description of lot to be built on: /
Street and Number where work is to be done.. . i. ..l 1 l
jj•• 1 1._Jti„1
State work to be done and purpose of building (by floors)._... eeE
t•t *A r, E ,� . S z e a L e›p N • r
be s O 1 1V
Disapproved ��
(Signed) t;c Y // 4
Buildi
MIAMI S L�A
VILGE
n
BUILDING INSPECTION DEPARTMENT. i�/t
APPLICATION FOR BUILDING PERMIT V 1
Date ...
nspcctor
PLAN
New Building Remodeling ion.. C\ C
odeling Addition. CC
To be constructed of�.. a kKind of foundation. E. G........._. R ._
Estimated Total cost of improvements $ oo . ` ►.... Amount of Permit 3�
Zone cubage required _Plan Cuhage
Distance to next nearest building. Size of Building Lot .
Maximum live load to be borne by each floor
Chairman
\1cri,ber
Member .....
Council Approved
NOTE: A charge of $1.00'
will ho made for
the 1'Linnin Board.
A ri••iii.t,.• fee of 31.00 will be charged
3n. Ieri3I. +net /ur workmanship. , •
or notices as are required by the Ac•t.•The undersigned agrees to employ only such su
permit, as are licensed by Miami Shores Village.
Remarks.. _ (Signed
STATE OF FLORIDA,
COUNTY OF DADE.' ss.
Before me, the undersigned uthorit a notary ublic du
pealed n. 0. . �.J . J •� �
and who, being by me first duly sworn, upon oath deposes and says that
of tl.e above describe /construction, that he has carefully read the forego'
therein by him stated are true.
4'1/
Permit No 1 % Date
C BOARD
Date
Repairs
authorized to.adniinister oaths a
ation, an
and for no Cher purpose:
No of Sto s�
oof Covering 3
1 hereb s .bmi�'(
t(a plans, and s cifiEatii n ff sai buildin All notices with r to the buildi and is ndd nstructionma
eat to. 1 ! ! � , 1 - 1�S5O 3T \ 1 � .
The undersigned aptilicant for this building permit does hereby certify that he understands and accepts his obligations as an employee,'
of labor under the Florida Vorknien's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Stippl4Kent,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
in the work to be performed under this permit; and will post or cause to be posted for insp2tio the site ch puhlir notice.
act r on .r to be perfu ed u. der this
Notary Public, State of.Florida
My Commission• ,Expirobtax2Lti.iliktIC . STATE OP FLORIDA AT L' .RCE .
MY COMMISStoNk s 4.6; -a ,7
e t rAi
DATHDED THRU,!GENERAt tier t M •t"t:
Member '
Member
Member ..
Disapproved Date r
making corrections or changes to this , opplication after approval has been obtained from
'
when such re- inspection it made necessary by improper notice for inspection or faulty