468 NE 100 St (16)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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.
Owner's Name and Address 7 r VL° g _c/i
e/ ,P,u Iex
Registered Architect and/or Engineer
--- and address of licensed contractor
Permit No. 24' Date 7.(0
Disapproved
(Signed)
Location and legal description of lot to be built on:
Lot / ` ' ct! Block r/ � Subdivision I4 MP PL /� ♦ZQ�"i .f
" �/
v Street and Number where work is to be done 'I e /,Q 7'
4-- work to be done and purpose of building (by floors). state exterior colors (submit samples)
1¢,0 , ' � 'L'� i9 �e ' c p a ve
New Building Remodeling Addition Repairs
To be constructed of Kind of foundation Roof Covering
/
� Oc�
Estimated Total cost of improvements $ 1 SC3 Amount of Permit $ Y 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 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 obligatons 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 at. • employ only su ontrac on work . be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Sign
STATE OF FLORIDA
COUNTY OF DADE. } ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
Building Inspector
Date
/355 - ff
Read, Sworn to and Subscribed before me.
v
Date J 2c 19�
No. e 0 Street )1 G /Qo J l
// 42o1 /1 03¢0ff
No. of Stories
Notary Public, State of Florida
and for no other purpose.
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.