30 NE 100 St (3)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 building
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 regula-
tions 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. p
°� %� f / Date_ /��f'°'� 191
Owner's Name and Address i ,) `' (i1 lam j '` ,, f %` � '�"` _ l' --; „ ,- No._ —_ - -- Street - - - -�_ —__ _
Registered Architect and /or Engineer A /,?:,,,;-/–<!,,L,"? ,r
Name and address of licensed contra .7;.-1 l ` , " –. �� –
Location and legal description of lot to be built on:
Lot fin" 1rf✓ c�'' i Block Subdivision
Street and Numbe where work is to �be done 52 0
State work to be done and purpose of building (by floors)
New Building
STATE OF FLORIDA,
COUNTY OF DADE.
Disapproved ____— __— _________________ Date '
(Signed)
Building Inspector My Commission Expires_
_Size of Building Lot
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member _
Member Member -
Member Member
Council Approved—______— _______ _______Date Disapproved
_and for no other purpose.
Remodeling __ Addition Repairs No. of Stories____
r /9,
To be constructed of_ -_ u________ Kind of foundation _= __�_____ �_:_= Roof Covering____ " -� _: ____ _.r__ —__
Estimated Total cost of i rovements $___ _Amount of Permit $___
Zone cubage required ��� ® Plan Cubage_ 2
_- 0a.
__ 1.
Distance to next nearest building_ —_
Maximum live load to be borne by each floor
I hereby submit J. all the p pans and specifications for said building. All notices with reference to the building and its construction may
be sent to-- ", w . r y ll?, /)
----- � --- - - - - -- G'a... -x < -e _...
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 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 ork to be, pe formed under this
permit, as are licensed by Miami Shores Village. ``- k- " i
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known.
and who, being by me first duly sworn, upon oath deposes and says that be is the
of the above described construction, that he has ca fully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated ateed are true.
Permit No.__ —�L� 1 Date_ .L / Read, Sworn to and Subscribed before me.
___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 notice for inspection or faulty
materials and /or workmanship.
LI
0 6
New Building__
be sent to
Chairman
Member
Member
Council Approved
Y _
To be constructed of_____ /;•t_ :;______ Kind / o)
Estimated Total cost of imp ovements S_ - 1:e.
Zone cubage required�l / 6 O
Distance to next nearest building__ —__ —_
Maximum live load to be borne by each floor
STATE OF FLORIDA, ,
COUNTY OF DADE.
Disapproved ____________ _ Date
(Signed) - -- — — —
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 building
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 regula-
tions 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.
Owners Name and Address_L�� _ �_ ` , _ — -
/
Registered Architect and /or Enginee l!;' a R �
Name and address of licensed contractor ' + ,
Location and legal des iption of lot to be built on:
Lot .V 1� fl Block___ _ Subdivision , t
Street and Number where work is to be done 0 + j 0 1_LL _L 4
f
f' v r p/ ( r f l•
State work to be done and purpose of building (by floors)
Remodeling_
I hereby submit all the plans specifications for said building. All notices with reference to the building and its construction may
The undersigned applicant for this building permit does hereby certify that be 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, erformed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to
appeared
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 ca fully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are t e.
Permit No.__ ____�____ Date — 9_f___ Read, Sworn to and Subscribed before me.
Building Inspector
MIAMI SHORES VILLAGE
PLANNING BOARD
Date
J 11/
Date_ Date_ —u -� 6 _• (---- l , 19
No.____ —_ - -__ Street—
_and for no other purpose.
Addition Repairs No. of Stories____,
foundation_ C Roof Covering —_
=s_ Amount of Permit $_ —
r
Plan Cubage 6 0
Size of Building Lot f ill X / / Y
administer oaths and take acknowledgments, personally
Notary Public, State of Florida
My C•mmis ion Expires
DATE
M e ..•
Member
Member
Disapproved _
to me well known,
__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 notice for inspection or faulty
materials and /or workmanship.