301 NE 101 St (15)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby umdc for the approyal of the detailed statement or inc plans and specifications herewith submitted for the build •
inc 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.
D ate ..._..._ CA ..._._ _._..._._�..._.... ,19• .'Z
ni/A � _ a` 10 1.. s r�P r-
Ors Name and Address ( .... Le 7 No . � . _.. Street..
Re Architect and /or Engineer 9 Dd a'! E /ZT -7 �✓7,
Name and address of licensed contractor /_16x0 N-41- 7 Avg ,/0
Location and legal description of lot to be built on:
Lot Block Subdivision
`301
Street and Number where work is to be done
STATE OF FLORIDA,
COUNTY OF DADE. ss .
E /gyp / 57/i. 7 "Tzip<1 5' 4e>l
peared
State work be done and purpose of building (by floors) ... "7Z °1Pk! 72 7d e..e .. f . f..._......_- .._.._.._—
4 b /Pr f2en c 1 P g-,T ti / d- /Ar G (4 6
_ and for no other purpose.
New Bui!ding Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation , Roof Covering
Estimated Total cost of improvements $
GO.0 r ,�t^
p 7,----... Amount of Permit S .. N
Zone cubage required flan Cubage
Size of Building Lot
Distance to next newest building
Maximum 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.. . SA ..on rief a4-ms 4.,zC o fy. 4J '7 / 4-!.// 4
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 %1'orkinen'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 she of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be Qedomed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally op-
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..� ... r7 Date ref.
Read, Sworn to and Subscribed before me.
Disapproved \.:. Date .._..
Notary Public, State of Florida
(Signed)
Building Inspector My Commission Expires _...._ ......_......._ . _ _.
PLANNING BOARD DATE
Chairmen 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 appmval has been obtained fmm
tlrc I'L Board.
A re. inspection fee of 51.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and/or workmanship.
Phone: 688-2569
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1460014.W. 7th Avenue. Miami. na. 3316a.
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146 00 N.W. 71h Avenue, Miami, Fla. 33168
.phoni::. 688-2569
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APPILSANCES.
MISCEITANSOWL
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nuts Approved.
Ara Understood
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THESE PLANS ARE APPROVED FOR
ISSUANCE OF A BUILDING PERMIT
VARIANCE(S) LISTED IN "REMARKS" :
MIAMI STORES BUILDING AND ZONING
UNLESS SPECIFICALLY LISTED BELOW._'
AND COUNTY LAWS MUST BE COMPLIED.,
Authsri?ed Signature • Date •
• WITH NO VARIANCES b WITH
NO 1:17•:', L DEVIATIONS MOM THE
ORDINANCES WILL BE PEPAITTED,
ALL OTHER APPLICABLE:STATE
WITH BY ALL PARTIES.
FIRE DEPARTMENT
PUBLIC WORKS
POLICE DEPARTMENT
BUILDING DIRECTOR
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PLANNING & ZONING BOARD
C VILLAGE COUNCIL
APPROVAL
PRELIMINARY: FONAL:
REMA2KS: . .
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O IPLIANCE MTH THE SOUTH FLORIDA BUILDING CODE AS ADOPTED
V L?IAni SNORES VILLAGE, T` (S REQUIRED. : E ARCHITECT, BUILDER 1?,
U CO�'�TACTORS ARE C! ',,pm, ¶' TI " !(0.•!! FDr,F r.r of 1 PIT p.
t G REGUtAYOONS`WHETHER OR NOT SPECIFICALLY INDICAYED HEREIN.