431 NE 100 St (6)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure hctein 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 iuilding Division of Miami Shores Village shall be complied with, whether herein pecified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address E a Mhone'y » ..._ » .._.,.. »
Registered Architect and /or Engineer
Building Inspector
L.
Name and address of licensed contrjtctor....O.rkin ...E.XtEi r.Yt3iiating.- .Co.... -- 1..960- .11LW.. ».27— A.veaiue
Location and legal description of lot to be built on:
Lot Block Subdivision _ ................. ---
Street and Number where work is to be done
State work to be done and u ose of building floors) __
p rn in ST (b r ) N�on , ,,T,ent-- �'t�- • g$ ti- exa
--.._.... p � y ... »........ »_... » ».._.._ »_.._.
_..__.. _ .__....
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering ._
Estimated Total cost of improvements $... Amount of Permit I.
Zone cubage required Plan Cubage
Distance. to next ne.uest building. Size of Building Lot
Maximum live load to bg 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 lo 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 sus •ntractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ' - __._._- (Signed)
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. I �/ ,
Permit No....... Z! 11 � _.1. ... Date �l � �V.� Read, Sworn to and Subscribed before me.
Disapproved II Date._ Notary Public, State of Florida
- (Signed)
My Commission Expires
to me well known,
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 corta Lions or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 31.00 will be charged when such re - inspection is made necessary by improper notice for inspeviitn► or faulty
materials and /or workmanship. -
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
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LOCATION OF STRUCTURE:
a ITER IS kix 3 ,, ,. -;/
1. ?E OF STRUCTURE.
Office.
Da1 th. Dept,
rnat OF CUBIC F MT (AFFRAIM TES' y d .
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NUE A1,D JPPROXD T1 . QUANTITY' G ' ' '' }'I(;1. ' -m STJL?' TJitYL FLUORIDE
A TE ADD APT ROXIIIATE TIFE CF P 'L ' :F, ' : ' ' •
LENGHT OF FUMIGATION PERIOD (A: PROX. _TE j, • 1 8n211. Hours
DISTANCE TO NEAREST STRUCTR.E ? 0 O:vr». 10 FT UNDER 1.0. FT;
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CERT IFIM . FUT.dGATIOI; . OFER. !TOR 7. OR SFEC IAL UYIGy TION
ID :TIFIC�}ION,
CARD HCT,T) P
,' NAI E JTf' " : PING
TLL FHONE: MY:
: : 624.6865
J ,i1?iI L_TICN SIi 1L;• BE P + CEL 'yam ):.; T 4‘' EL Tft'FA,,121 STR1C T r,DH MTCr
V17.712-107 F_;CTSTER 1) J,Ji LL ' -J ]) FL E y ' TE F y EG ATI
:' � � i�� �'HC-�:�.D Gi r :�LTH F._.GtLT A�_GP1S'
TENT
Corl CBS
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BUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
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CONTRACTOR or BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT x^ 9812
131
Work to be performed under this Permit
r
BY
Date ' "� 19
Contractor's / 7 7
License No
•
Subdi-
vision
Sq. Ft.
Value of 9 � 11 Amount of r
Project $ 11 Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that ha assumes respon-
sibility for work done by his agents, servants or employees.
Signed• _ " " . ' ` ;./ e -.
• , (INSPECTOR) BY
In consideration of the issuance to me of this perrltit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plan$, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
AUTHORITY