836 NE 100 St (7)MIAMI SHORES VILLAGE
BU!LDIN " INSPECTION DEPARTMEN'
APPLICATION FOR BUILDING PERMIT
Application is hereby made fob' the approval of the det.iled statemem of the plans and specifications herewith submitted for the build-
ing or o h :ructure her i descrild. This t-t-licat ;c is made in compliance and con-o *m-ty w.th the Building Ordinance of Mia ni
Shores Villaee, .or da, and all pro. isions of the Laws of the State c•f IIkrid. all o d nances of Mi .nn Shores Village and all rules and
regu•a ion, of the Building Div. ; of aam Sho. iilage 1• 1 1 e o ipl.ed with, whether herein specified or not. A copy of approved
plans and specificat; .nr• must be ken • at building durin, progress of the wcrk.
Owner' Name and Address
Registered Architect and /or Engineer___ __ _
Name nd address of licensed contractor.
Location nd le ' 1 descri tion of lot to be b ilt on:
Lot __. __ °_g / Block___ ___.l Subdivisio
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
Permit No.___
Disapproved
(Signed)
Chairma
Member
Member
Council Approved.
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
pector
1'
NOTE: A charge of $1.00 will be made for
the Planr ng Board
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
ei No Street_.
and for no otheF purpose.
New Building_ ______l_ Rernodeling__ ____ _ __. ddition.___ _.__ ___ __.. __ _ Repairs. _ No. tories; �_
To be constructed of_ _ -S _ Kind of fo ation - o C _ of _- _ torte
Estimated " ;tal cost of improvements $._. . = =_!'r :✓" Amount c`. Permit $__
Zone ^ubage required_ __. __plan Cubage T _
j _
Distance to next nearest building__ _ _ 0 Q ,__Size of Building Lot " f- * -11
Maximum live load to be borne by each floor. _ . _____
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 unde signed appli ant for th 's building permit does hereby certify t'iat he understands and accepts his •bligations as an employer
of I bor under he Florida Workmen's Compensation Act being S- -tion 5966 Col p led Gen al Laws of Florida P r anen. Supple Went,
and h s compl ed w th he prov' cons thereof, and will require similar comp lance from all contractors or sub-contractors emplo :ed by him
in the wo k to be p rt med under th s pern it and ill post or cause to be posted for inspect on on the site of the Oast' :h public note e
or •otices as are requir d by the Act. The u. d, r ign.-d agrees to employ only such abcontr cto;4, on work to 1 iie{form d . der this
permit as are licensed by M am, Shores N, it:: ge.
Remarks__
PLANNING BOARD
Member
Member
Member
. ___ _Date
Date Q ' , 19
(Signed) ad",k4/.' '
Before me, the undersigned authority, a notary public, duly authorized to adm_nister oaths :.nd take acknowledgments, personally 'p-
peared
and who, being by megirst d. ly Qworn, upon oath deposes and says hat he is the
of th abov de& ibe •,struction. t... h has reially read the regoing application, and that he did sign the same, and that all facts
therein by him stated(e tr ie.
__ ?__ _ _______ _' ' Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com_nission Expires.
DATE
to me well known,
Disapproved _ Date
making corrections or 2hanges to this application tfter approval his been obtained from
when such re- inspection is male necessary by improper notice for inspe:•t•:m or fa. Ity
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