468 NE 100 St (2)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or roe 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..
Owner's Name and Address 1 (/ �_ r/ - �_ / . _ / r_ _ No. ./00
Registered Architect and /or Engineer vv
Name and address of licensed contrpctor. :.• t. Y4�3...r
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 purpose of budding (by floors) ec.).fJ_l` /1
( 7 on, Sk.[
res,' ,err.fr._ ..._.... � t., • F7,, J` ..... ..s 145.... E la' 1-L9 6
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories / •
To be constructed of Kind of foundation Roof Covering 14 . /........ 77-e. _
Estimated Total cost of improvements $ / ? Amount of Permit $..1.
Zone cubage required .Plan Cubage
Distance to next nearest building.. Size of Building Lot
\faxiunum 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 permit does hereby crrtify that he understands and accepts his obligations as an employer
of labor under the 'Florida Workmen's Compensation Act. being Section 59G6, Compiled General Laws of Florida, Permanent So i lenrent,
and has complied with the provisions thereof, and will require similar compliance from all contractor. •r sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for ' s ection .,/ e s of t work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such tractor /on r. ormed under this
permit, as are licensed by Miami Shores Village. ' llj /
Remarks (Signed).. . _ /
qp
Date
0f/i- t'_C< rAK
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.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, snd that all facts
therein by him stated are true.
Permit No /7% 0,6 Date 4
Disapproved
(Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
uilding Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Nfc r ber 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 Pl.innir,;; 1to.rrd.
A re- impection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
s3osr