400 NE 100 St (5)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal of the detailed statement of the plans and specifications submitted for the build -
ing or other structure described. This application is made in complianra and conformity with the Ordinance of Miami
Shares Village, Florid., and all provisions of the Laws of the State of Florida all ordinances of Miami Shores V 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. SEFT• 1 . 19 G /
Owner's Name and Address..... . R.,c°.4. TE No 4Q2 Street.. MA E, /OP TAY• ,,T-
Registered Architect and /or Engineer /'�
Name and address of licensed contractor....e.,Yd..17.4.41/
Location and legal description of lot to be built on: cc
Lot.... 8 .l Block Subdivision./i E4e1.1..... d..S l ...1 cam• .� .... N► D D .
S rmat Ad Number where work is to be done 490 _..111 :.E .... 1 . 0.0 . iH..... ST
Stabs wan be done and purpose of building (by floors)
�.l.N..K........ Y'
New Building. ».».
To be constructed of
stimated Total cost of
Zone cubage required
Distance to next nearest building..
Maximum live load to be borne by each floor
Disapproved L ���.. ». »... f Dat
...... .....
(Naiad) �
EA/c E Cp
Remodeling Addition Repairs No. of Starks
Kind of foundation Roof Coveing
improvements $...,.68 • O 0
Amount of Permit $
Plan Cubage
...Size of Building Lot
A/. _.....
J . 1!✓ .. :....1.4 .3 AP.
and for no other purpose.
I hereby submit all the plans and spedficatknu for saki buil ding. All notices with reference to the building and its construction may
besent to .. .. _ . .»_.._.....»........._.. ...._..._......_..._......_.._.
The under:limed applicant for this building permit does here*certify that he understands and accepts his obligations as an rmployer
of labor under the Florida Workmen's Compensation Act. being vctkeri 5988. Compiled General Laws of Florida. Permanent Supplement.
and has complied with the isions thereof, and will require similar compliance from all contractors or subcontractors employed by him
in the work to be'perf wider this permit; and will post or cause to be posted for inspection on the site of the work such blic notice
or notices as aro require by the Act. The undersigned agrees to employ only such subcontractors on work to be performed under this
permit, as are licensed by Miami Shores Village. CHASTA /n / FENCE o.
R marks..
(Slgned)q _ `
STATE OF FLORIDA.
COUNTY OF DADE. f sa '
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.--- !� `. . ... .. .Date l ...... Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
LANNING BOARD DATE
Chairman Member
Member. .._.._..._ .................._._ ....._._ . Member ..»
M 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 hecn obtained (min
the Planning Board.
A reinsp.ctien fee of into will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or wodissanship.
cOS ,)A (C
O
4 4 -
/Yoas
4
'al e
lnI — l ® o rs l� o
/