253 NE 101 St (3)Owner's Name and Address ......1
Registered Architect and /or Engineer �[
Name and address of licensed contractort4�� !!�
Location legal description of lot to be built n:
Lot /r Block 3 ...
Street and Number where work is to be done
State work tZone a d pu •sc of bbuild��/g (by
STATE OF FLORIDA,
COUNTY OF DADE. } ss.
MIAMI SHORES VILLAGE.j , q77
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby spade for the approya1 of the detailed statement tit me 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.
Date..._ ... ,191
r 5. . Street. ../U'•.. #
//
44 6 /3 4 /.6' 0 0
Subdivision. . •
5 fr t
st-
9 . ,,t„ ..... ... ..... t..,,..,t.ft.t•.,ff,.,ai
66- & ec,?e 7
_...�.__ and for no other purpose.
New Building Remodeling....( Addition Repairs No. of Stories
To be constructed of i:d of foundation Roof Covering
iit�
Estimated Total cost of improvements $...11 Amount of Permit $.. !.1
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 Florida, Permanent Sup )lenrent,
and has complied with the provisions thereof, and will require s lap compliance from all contractors or sub - contractors 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 notices as arc required by the Act. The undersigned agrees to employ only such subcontr or on work to be pe formed under this
permit, as are licensed by Miami Shores Village.
Retn,uks (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 true..
Permit No.._ . 1 . 5. ii6 0 Date t' Read, Sworn to and Subscribed before me.
Disapproved ... Date.
(Signed)
Building Inspector
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
\!ember .. .. _....._......_..._._...._ 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 fmtn
the 1'Lurnir.;; liu.rrd.
A rein.pection fce of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection at faulty
materials anti /or workmanship.
Great American
Kitchen & Bath Design Inc.
21190 HOLLYWOOD BLVD.
HOLLYWOOD. FLORIDA 33020
Dade: 940 -9077 Broward: 921 -2119
CEILING
FLOOR •
NAME H eS C, 14 L %3(2 -1A 1+
ADDRESS 2.53 t.4 E I OI ST
PHONE 44 757 — L i CI
5 1
$S
CAB. MICA
DOOR MICA
COUNTER TOP
BACK SPLASH
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APPLIANCES: — REFRIG.
SINK RANGE COOKTOP
OVEN DISHWASHER
FAUCET DISPOSAL TRASHMASHER
DOOR STYLE
DRAWER STYLE
HARDWARE
SCORE TYPE
\ZO
ADJ. SHELVES
K.V. GUIDES
SILVER DRAW.
PULL OUT SHELVES
OYES O NO
❑ YES .N0.
D YES NO
OYES O NO
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PL u ri 13 4ELE E LEL 6 4 6T"I erS
l�IST�I� »eM) 441PL 14 N« I
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I UNDERSTAND & APPROVE THIS PLAN
APPROVED BY:
CUSTOMER DATE
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