94 NE 100 St (7)Disapproved
r
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.
/ I aja�e
Owner's Name and Address4vA-C Z /m' �"!!5�✓ No.
Registered Architect and /or Engineer
Name and address of licensed contractor. z6
Locatiop apd legal esgsi tion of lot to be b ilt on:
Block Subdivision_ / / F���
Street and Number where work is to be one -
'1,�L��J
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor_
I hereby submit all the p
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
ate_
� - 3,3 21 e
. ,19 7 e
L street 22 6 /
State work to be done and purpose of building (by floors)
New Building Remodeling Additio
To be constructed of Kind of foundation Roof Covering
_ _Amount of Permit $
plan Cubage
Size of Building Lot
ations .'I said buildi g. 1pll notices with reference to the building and its construction may
The undersigned applicant for this but ding permit . . s here bry ertify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation being ection 5966, Compiled General Laws of Florida, Permanent Sup lenient
and has complied with the p rovisions thereof, and will require similar compliance from ntractors or sub- contractors employ by him
in the work to be performed under this permit; and will post or cause to be posted fo the s of the work such p lic notice
or notices as are required by the Act. The undersigned agrees to employ only such ork to be per .rmed( pder this
permit, as are licensed by Miami Shores Village.
Remarks__._ .
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
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.
o�
Permit No / Z. 3.7 D. e 7 — Z_L 7" Read, Sworn to and Subscribed before me.
( Signed) ! .� % ` --
Building Inspector My Commission Expires
_Date
Notary Public, State of Florida
PLANNI / : BOARD ____.- DATE
Chainnan _ _ Member
Member Member
Member _ Member _..
Council Approved Disapproved
and for no other purpose.
Repairs No. of Stories
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 not '.e for in, al or faulty
materials and /or workmanship.
4 vm /./" 005 (20/1/;) 4'per� re Aconi
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