270 NE 101 St (10)3N
))1 S � ,i BUILDING INSPECTION DEPARTMENT
ll 32dd /3 ` / APLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement Lit um 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 nII provisions of the Laws of the State of Florida. all ordinances of Miami Shores Village and all rules and
regulations of the iuilding 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..._... - .. _._ _! 1 _ , 19. 7
Owner's Name and Address 9 / 11 ....... _ - No? -7 L S Str °?70 �-� L c `u� 3A -raft
Registered Architect and /or Engineer
Name and address of licensed contrlctor
Location and legal description of lot to be built on:
Lot Block Subdivisi
97C) k\,E ► A 1 S--k-caL
Street and Number where work is to be done
State work to be done and purpose of building by floprs)
MIAMI SHORES VILLAGE
Building Inspector
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a a.
f36 —.1 I
I'lat'%1�L �h cb�` �' ���(F-r I
7:04-
and for no other purpose.
Ncw Building Remodeling Addition Repairs No. rlf. es ,
To be constructed of hind of foundation oof Covering 1 I L .
Estimated Total cost of improvements $ ^ 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 pennit 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 inspection on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only su u actors on rk to be performed under this
pennit, as are licensed by Miami Shores Village. K--(L(1)LCI-) Remarks.... (Signed
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 -
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the. h) \S
of the above described construction, that he has carefully read the foregoing application, and that he did sign the me, and that all facts
therein by him stated are true. t i
Sworn to and Sub • . be a me.
Permit No.._.... S.; Date
Disapproved A. Date. ._..- ' ----- '
otary Public, Scat . '; yn • a • _ ._ (Signed) li ommasion Expires June 1, 1901
My Commission Expires yiivua .ter..rw,.r.;o..Nwwcs..1ss,. —.—.
PLANNING BOARD DATE
Cirair:nan Mcmbcr
\Icrnbcr 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 P1. nnir,;; Board.
A re fce of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection of faulty
materials and /or workmanship.