321 NE 100 St (11)BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby uindc for the approval of the detailed statement u, ine 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 n11 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 progreu of the work.
Owner's Name and Address
Philip A. Villangeva_ M.D
Registered Architect and /or Engineer
. 7 5 : 2 .... ,
Name and address of licensed contractor... Card.] l .IIal...k'_e.D.Ge...GOmpaD.y.... 1123. -. ITT.1 1... .— Zth...AVe.....M1amL.,... .5i
Location and legal description of lot to be built on: 1
Lot 15 a 1f Block. 39 SeD.... ... Subdivision. ... Miami ._Shores_ .._.__..
Stzeet and Number where work is to be done.32.1...N..E......10IIth -. .St. -- -- ••---- •- ••- ---- -- - —
State work to be done and purpose of building (by floors)....._ I.S1A d.l.1..197_ lin £h_Rf ..S-ft .chain li.nk_fence
and for no other purpose.
New Building Remodeling Addition X Repairs' No. of Stories
To be constructed of land of foundation Roof Covering
Estimate Total cost of improvements $ 8.5.0..1/0 Amount of Permit 3.
Zone cubage required .Plan Cubage
Distance .to next nearest building.. Size of Building Lot .1 ...X...11Q
Maximum live load to be borne by each floor
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 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 Sup ,lewent,
and has complied wit', the provisions thereof, and will require similar compliance from all contractors or subcontractors employe 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 noticcs as are required by the Act. The undersigned agrees to employ only such •ntractor on rk to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Rem.uks (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 construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fads
therein by him stated are true.
Permit No..__.._ Date Read, Sworn to and Subscribed before me.
Disapproved ........_...._ Date —
(Signed)
Building Inspector
Cnair:nan
Nierr,ber
Member .. _....._......_..._._...._
Council Approved Date
NOTE: A charge of $1.00 will be made for
the PIannir.g Board.
A re-inspection fee of 31.00 will be charged
materials anti /or workmanship.
MIAMI SHORES VILLAGE
Date..._..._..._ December_ 2 Ot _._..._.....
._ Street.E 1Q.Qth St.....
„„. T1 TO • ...............
Notary Public, State of Florida
My Commiuion Expires
PLANNING BOARD DATE
t- tvwrgA)
eft.i,elw e
Member _ ...
_............_
Member
Member ...._ -- .._. ....—
Disapproved Dale
making corrections or changes to this application after apprn al has been obtained from
when such re- inspection is made neceuary by improper notice for inspection or faulty
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39, SECTnoH #1, M1AM1 SNORES. FLORIDA.