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504 NE 101 St (5)MIAMI SHORES VILLAGE 7s7 sy7( BUILDING INSPECTION D'EPA'RTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement in we plans and specifications herewith submitted for the build mg 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 regalations 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. Date..--- Namc and Address ...... .Y.l . ...... { �?sd: l `r ._ No._ .._. Street. ....- g� . ... . . ... Registered Architect and /or Engineer..•.. •. fL O M 4J.. . .. ... t ,,,.. ,,. , „,,,,,,,,, „�,,,� Name and address of licensed contractor....):a1 . Q b. . A?.�t�5,1 . .1�?sl�_. _ L»� U...... . :1 Location and legal description of Jot to bc built on: 1 s! 3018( /T f e 7 & t e l o� k© (qs Fast ock ! 5 S vison t a'nd 'umber wt eru work is to be done C Sb 1- 1 J e O. 1._ ... t . ate. .. _� St to work to be done and purpose of building (y floors) (IL 14.80 t_ . _ Q--\ (CLtti STATE OF FLORIDA, COUNTY OF DADE. ss. Building Inspector -- and for no other purpose. Ncw Building ' /Remodeling V Addition Repairs No of Stories _ To be constructed of ... OC -!'�. Kind of foundation 0:Q6 rc . 1 e t RooCovering ..(2)Dr Estimated Total cost of improvements $ 1 0 f . O Amount of Permit $�.. t.11. 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 ss bmiit all the plans and specificat' ns for s id building. Jill notices with reference to the building and its construction may be sent to.: 161 0 .1[1,... &I - y ∎G .roe, t•0 ✓\ 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 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied svitlt the provisions thereof, and will require similar compliance fro r all contractors or sub -cnntr ctors employed by him in the work to bc performed tinder this permit; and will post or cause to be poste nsp ction on the site • ,itj rk such public notice or noticcs as arc required by the Act. The undersigned agrees to employ only su v ctors, on r perfo•••ed under this pcnnit, as are licensed by Miami Shores Village. Remuks (Signed) �t 1. � t `� °�ill eg7 Before me, the dersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared cigar d G ocier, - to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the....G. ierte C.-0/11 y of the above described construction, that he has carefully read the foregoing application, and that he did sign the saline; tad that ill fads therein by him stated are 1 Permit No..- »!"K' Date Read, Sworn to and Subscribed before me. ` Disapproved Date .`.'e-k- ..�.1 NotaryXublic, — Sttate of Florida - (Signed) My Commission Expires ., „• NOTARY ?!fit &.IdFOE f:dR.clU. » MY COMMISSIONJXO,'MAY 29,1989 BOOED THRU GEMIAAL IRS. UMO.. PLANNING BOARD DATE Chairman Member ? _.. »_.... .. ........ . .. ..:.• .. »._ Member Member Member .. .. Member ....» _.._...., Council Approved Date Disapproved Date NUTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the I'Lrnnir.. A r1 - in'pr•i tion 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.