345 NE 100 St (7)New Building Remodeling
To be constructed of (4 Kind of foundation
Estimated Total cost of improvements $ tt c oQ
APPLICATION FOR BUILDING PERMIT
Application is hereby made 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 tlic 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 progress of the work.
Owner's Name and Address ... .J... L_
Registered Architect and /or Engineer
Name and address of licensed contactor
Location and legal description of lot to be built on:
Lott? 21. J ,2. Subdivi
Street and Number r work is to be done.
State work to be done and purpose of building (by floors) _ ./ .�f
Addition Repairs No. of Stories
Roof Covering
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 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 Flori.., Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from al - - ttractors or su. '*tractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for ' spe• ion on the s the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such ��• . r. on t . per ed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Sign
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
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 ted are true.
� /
Permit No..___ I� Date - Read, Sworn to and Subscribed before me.
Disapproved D
( Signed)
1-22 Notary Public, State of Florida
B uilding nsp for f My Commission Expires
Chairman
Member
Member ...... _....._..._.�...._
Council Approved Date
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
PLANNIN BOARD DATE
Date... . ._._.__._...._......_........ ,19p7;
._ No..... Street 0C C L & f ! .
CI.... . TM • T: tT•CTT•VITtI TTT••• tfITtfitt•T• •..
and for no other purpose.
Member
Member
Member
Disapproved 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 13o:ud.
A rc inpcction 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.
to me well known,
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