429 NE 101 St (12)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 0 / 5 4 e 7 ' 677-° 848.5
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block
constructed of Kind of foundation
ted Total cost of improvements $ Z
STATE OF FLORIDA,
COUNTY OF DADE. ss
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
ate__
//
■/v /z/a. Co.
No Street
'7 /
,19
p S7' C
` Subdivision
7 Z-! V. 6, /O/ .CT
Street and Number where work is to be done
State work to be done and purpose of building (by floors) 2 • `' •
Z �- - TON ,E S',z- r
�� -/ e Cie t� c� � f2�� 'bv `S f 'E i Cu dl j- a fid for no other purpose.
Building Remodeling Addition Repairs No. of Stories
oof Bring
(.(
J
}
Amount of Permit $
ne 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 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
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of
and has complied with the provisions thereof, and will require similar compliance from all contractors
in the work to be performed under this permit; and will post or cause to be pos ...... •n
or notices as are required by the Act. The undersigned agrees to employ o
permit, as are licensed by Miami Shores Village.
Remarks _ (Signed)
c subco
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, and that all facts
therein by him stated are true.
Permit No i_ J __ / _ A Date i 4 - '7 I Read, Sworn to and Subscribed before me.
Disapproved ' l /� Date
(Signed) ____' �.�I as
Notary Public, State of Florida
his obligations as an employer
Permanent Supplement,
actors employed by him
the work such public notice
• performed under this
g Inspector My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
Disapproved Date
making corrections or changes to this application after approval has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
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 ke at building during progress of the work.
;Q
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor f7 r� � ' ' ___ , ' 1 /f.44, • v6
State ork to be done and purpose f building by floors)
Location and legal description of lot to be built on:
Lot Block w,
Street and Number where work is to be done `f Z
Permit No Date
Disapproved Date
( Signed)
Building Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Subdivision
/ci
' etCLO
Tom
I hereby submit all the plans and specifications for said building. All notices with reference
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of
and has complied with the provisions thereof, and will require similar corn
in the work to be performed under this permit; and will post or cause to b
or notices as are required by the Act. The undersigned agrees to employ on
permit, as are licensed by Miami Shores Village.
Remarks (Signed
/ /1>' 3 ,19
• No Street
to the
'3,0
7
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of d i on Roof Covering
Estimated Total cost of improvements $
Amount of Permit $
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
Maximum live load to be borne by each floor
STATE OF FLORIDA,
COUNTY OF DADE. j 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, and that all facts
therein by him stated are true.
Read, Sworn to and Subscribed before me.
building and its construction may
gations as an employer
a, Permanent Supplement,
contractors employed by him
e of the work such public notice
performed under this
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman 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 approval has been obtained from
the Planning 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.