504 NE 101 St!I 3.ZoG 17 / /y0 7
MIAMI SHORES VILLAGE I J (9 14
BUILDING INSPECTION DEPARTMENT ` g3S J 1.14;d7
APPLICATION FOR BUILDING PERMIT ,t3
Application is hereby made for the approval of the detailed statement ur trte plans and specifications herewith submitted for the build •
ine 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 cupy of approved
plans and specifications must be kept at building during progress of the work.
STATE OF FLORIDA,
COUNTY OF DADE.
S S.
Building Inspector
Owners Name and Address .0 l
Registered Architect and /or Engineer
Name and address of licensed contractor.44
Location and legal description of lot to be built on: •
Lot
a' 1 Block q. Subdivision... l4
Street and Number where work is to be done .50 '
State work to be done and purpose of building (by floor ) I,d,.le
1- WAxiev r�,...
New Building Remodeling ,."4. Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ lg :.Qf Amount of Permit S.
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 for said building. All notices with reference to the
be sent to
building and its construction may
& 2A.1.� l3 a .... .... . ...... .Ioc ('u,) 1 .. ?�.? >. !larva. 3 31 6 to
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 Workmen's Compensation Act. being Section 5e966, 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 fo inspection on the site of•the work such public notice
or noticcs as arc required by the Act. The undersigned agrees to employ only such �• •ntractors, on ,or to . performed under this
permit, as are licensed by Miami Shores Village.
Remarks .— _._.__ (Signed)
Before me, the undersigned authority, a notary public, duly authorized o administer oaths and take acknowledgments, personally ap-
peared 3 2S R rn vuye
and who, being by me first duly sworn, upon oath deposes and says that he is the. rn16 -i 1✓20,..c.,
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. 4 7 3 c
Date fl s?! ee,
Disapproved � .. � .... C Dat 11
(Signed)
PLANNING BOARD
Citairinan
—
Merr,ber
\tembcr .. ... _ ....._......_..._. ...._
Council Approved Date
,19.
»_... and for no other purpose.
Rea
Date.... — l
tI:tt
t.•••t,. *ft Httla?A.••• 4111
. __25._15 _P4..14
d, S to and Subscribed before me.
Notary Public, State of F orida
My Commiuiy. C OA ∎ ∎ SAT - G 7- 75 .. ---
k1ONDEN c}:it GENERAL 1NSUBANCE UND -
Member
Member
Member __•
to me well known,
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 I'l, nnir.g 13o.trd.
A re- inspection fee of 31.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.