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37 NE 100 St (8)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 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 Fkridi , all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village hall be complied with, whether herein specified or not. A copy ot approved plans and specifications must be kept at building during progress of the work. 9 ,, t3 , Owner's Name and Address Date No Stree Registered Architect and Name and address of licensed contractor. Location and legal description of lot to be built on: Lot. Block.. Subdivision Street and Number where work is to be done 37 C- 616 State work to be done and purpose of building (by floors) Distance to next nearest building Maximum live load to be borne by each floor Disapproved Da (Signed) Buildin! and for no other purpose. New Building Remodeling._ Addition. Repairs._ .. . No. of Stories ... To be constructed of. Kind of foundation Roqf Covering.. Estimated T-ital cost of improvements $... Amount c Permit $./ f° Zone cubage required _Plan Cubage Size of Building Lot 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 ilea 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 Supplenient. and has complied with he provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the woik to be p rf.;rmed 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 requir. d by the Act. The undersigned agrees to employ only soc subcontrctors, on wor' t • be perform d raider this permit as are licensed by Miami Shores Village., Remarks. . . (Signe ... STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally pp- peared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of th abov. de,c.ibed aistruction, t1t he has carefully read the foregoin application, and that he did sign the same, and that all facts therein by him stated are true. Permit No 2.1 Date 4 7 1 Read, Sworn to and Subscribed before me. Notary Public. State of Florida My Coin:nission Expires. PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved .Date Disapproved Date NOTE: A charge of SIM 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 mt: lie necessary by improper notice for insptietion or faolty materials and/or workmanship. 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. Owner's Name and Address Registered Architect and/or .eigA421&," Name and address of licensed contractor Location and legal description of lot to be built on: Lot_ Block_ Subdivision Street and Number where work is to be done State work o be done nd purpose of buil ing (by New Building To be constructed of ______ _________ Kind of foundation Estimated Total cost of improvements of Permit $_ Zone cubage required__ APPLICATION FOR BUILDING PERMIT MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Remodeling Addition__ Date_ __Plan Cubage and for no other purpose. Repairs No. of Stories__ oof Covering___ 1 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 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 i spection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such su ntractors, on work to be ormed nder this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No–___—_______ Date Disapproved __ Date (Signed) Read, Sworn to and Subscribed before me. Building Inspector My Commission Expirm Notary Public, State of Florida PLANNING BOARD DATE Chairman Member Member Member Member __,__ Member Council Approved_ Date 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.