315 NE 101 St (10)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 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.
Owner's Name and Address._
MIAMI SHORES VILLAGE
Registered Architect and /or Engineer...
Name and address of licensed contractor_ G574 � t�E�+/ CID _Ale ` 71_S _ _ d(/t_6N_ . ".tea.,
Location and legal description of lot to be built on:
Lott_ ° P /' /S Block .p8 _ Subdivision. _ r / Apra/D.
Street and Number where work is to be done 3/6- . N. OE / / f
State work to be done and purpose of building (by floors) _. CAV A r "' "AI IC /" e°^V
----- - - - - -- - - and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation___ Roof Covering
Total cost of improvements $ 3° QC ' Amount of Permit $_7 p 21
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 the plans and specifications foi said building. All notices with reference to the building and its construction may
be sent /c a eo /ive• 7/85 N. 6✓ 26 • Ake .
The undersigned applicant for this building permit dot 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, Pennanent 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 ins ection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su- - ors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Sig er .
STATE OF FLORIDA,
COUNTY OF DADE. j ss •
Before me, . undersigned authority, a notary public, duly authorized to administer oaths and take ack.rowledgments, personally ap-
peared
and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, 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 6 � v .. Date_.._. �' .. Read, Sworn to and Subscribed before me.
Disapproved
( Signed)
Chairman _
Member
Member .
Council Approved
f� ..
Date ,19 65 "
No. 3/5 _.__ _._ Street /V. £• / 0 /PF k 7:
to me well known,
Date
Notary Public, State of Florida
uilding Inspector / My Commission Expires
Nc r- 222 ",e a/ seesr
PLA ING BOARD__ __ . . . DATE
Member
Member
Member . _._ ...
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 Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.