271 NE 101 St (13)Owner's Name and Address ____5 /A N V sl 0 _4 IV 5 ` 0 j
Registered Architect and /or Engineer t4AP)u - eS
Name and address of licensed contractor _ __
Location and le ml description of lot to be built on:
Lot__ 1'L -2 - 0 Block
Street and Number where work is to be done
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Disapproved Date
( Signed)
Remarks ( Signed ) _
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
i 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 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 Vl+� ` t , 19c
No Street
S01 <..Q
1
Subdivision __ \11_l4. n3 eC _
State work to be done and purpose of building (by floors) __ � M gS `" 7 �✓ -__._
ryry���� ' v r and for no other purpose.
New Building ____f!1!/4( Remodeling Addition Repairs No. of Stories 00e
To be constructed of C C. S Kind if foundation Et" Q O Roof Covering__ It LE
^ '4312' 00
Estimated Total cost of improvements $____ �} C 0W _____Amount of Permit $ I �4' Q -
Zone cubage required L 0 0 • ____Plan Cubage � - � y 3 V�?
Distance to next nearest building JS Size of Building Lot l X S
Maximum live load to be borne by each floor °1 7-0-
__
I hereby s it all the plans a specifications for said building. All notices with reference to the building and its construction may
be sent to s it
k) Co a t3S 1D N
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 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 subcontractors, on wor to be performed under this
permit, as are licensed by Miami Shores Village. -, .
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgment(, 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 Date Read, Sworn to and Subscribed before me.
Notary Public, State of- Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member 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- 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.