205 NE 101 St (3)Application is hereby made for the approval of the detailed statement ot xne 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 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 progress of the work.
Owner's Name and Address
1.7 . l .T11,111,!•11 .•".
Registered Architect and/or Engineer . %A. 1) Pr - 4---ekae-2.- 5. a-- 5Qcj, 1
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot B Block / Subdivision 11A a oe-2 cm .
Street and Number where work is to be done 2.0.sr 2/ • g .../.0 / s r•
State work to be done and purpose of building (by floors) t • 4 .s .
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
and for no other purpose.
Ncw Building Remodeling Addition. Repairs No. of Stories
To be constructed of -C13.5 Kind of foundation Rge• Roof Covering
Estimated Total cost of improvements $ a.40.00 Amount of Permit $.
Zone cubage required _Plan Cubage
Distance to next nearest building /0 Size of Building Lot dPio a X 3
Nfaxiinum 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 xindersigned applicant for this building permit does hereby certify that he understands
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Cener
and has complied ith the provisions thereof, and will require similar compliance from all con
in the work to be performed under this permit; and will post or cause to be posted for inspect
or noticcs as arc required by the Act. The undersigned agrees to employ only such subcon
permit, as are licensed by Miami Shores •Village.
Remarks (Signed).
STATE OF FLORIDA,
COUNTY OF DADE. ss *
Before me, the undersigned authority, a notary public, duly authorizcd 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 stated are true.
Permit No h Date ‘)0 Read, Sworn to and Subscribed before me.
(Signed)
Disapproved Date
Date
a a'cepts his oblig iployer
s of Florida, lenient,
s or sub-con by him
the site of c wor su puli c notice
on work rider this
Notary Public, State of Florida
to me well known,
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Nfernber Member
Member Member
Council Approved Date 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 Board.
A re fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials anci/or workinanship.