205 NE 101 St (6)APPLICATION FOR BUILDING PERMIT
Application is hereby usnde for the approval of the detailed statement uu 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 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.
STATE OF FLORIDA, 1 .
COUNTY OF DADE. J ss'
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
Vo
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 31.00 will be charged
materials and /or workmanship.
Owner's Name and Address
Registered Architect and /or Engineer..... •.
Name and address of licensed contractor..E
Location and legal description of lot to be built on:
Lot Block Subdivision . . / . �, ... / _ � ._.. � . - .- ...._.
. �. � J. ._.!7 !..l!�.r.....(.JI.C.>�e � rE
Disapproved �.. _ _ , Date
(Signed)
Cinairtnan
Nferr,bcr
Member .. ...
Council Approved
Date
Date... "�! . 2 ._...._._..... ._._-- .__..._... ,19e2
C ..-:_ ._ No...._ .... ..... ...._. Street--
PLANNING BOARD DATE
r• ,,,•••,re•• r na�rw,•e•
Notary Public, State of Florida
My Commiuion Expires
Street and Number where work is to be done
State work /to be doe and purpose of building (by floors). a �t..4::{.: �'L.. G.0241.e.
and for no other purpose.
New Building ' Remodeling Addition Repairs No. of Stories
To be constructed of Kind �� of foundative. Roof vering
Estimated Total cost of improvements S � nn Amount of Permit S. 'j
Zone cubage required plan Cubage
Distance .to next nearest building Size of Building Lot
Mfaxirnum 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 un(iersizncd 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,
anti has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hips
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 subcontyactors, one rk to be petformed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
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 facts
therein by him stated are e.
� _ ..: �
Permit No.._.._._._.:..... Date 4 1 Read, Sworn to and Subscribed before me.
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by Improper notice for inspection or faulty
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