600 NE 101 St (6)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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 1 •
1 S_ • _. Nocb o .._.. StreetN �- °A. SLIT _
Owner's Name and Address -K) '"
Registered tvchiteet and /or Engineer
•Tame and address of licensed contractor
Location and legal descriptipp lot to be built on:
Lot \u 1 Z_ T Poa e a i
L
El
A Block ! 0 Subdivisions 1 A'" 1 7 N QSL-TS VIE- G� --•- 4 pj3 IS PGA A-
� ... .. ...... . _.. _. � _. -
Street and mber where wort. is to be done Q N _ 4S 1 S 'f' ‘-i.. , `
State work to be done and purpose of building (by floors) C Q \z x r a4,_C- gC) T
yTlt_ 'y -. CG ` CZszlo .r.r, — -1 t R. ,. Ct- -iP &ciN
\ _ and for no other purpose.
New Building Remodeling Addit bn4 Repairs No. of Stories
To be constructed oK--1R O' 'of foundation C. • C.J'z^' Cr-. RO Lying '1" i:.,,. ...,
S' '.c
Estimated Total cost of improvements $
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby s mit all the plans and specifications for said building. All notices with reference to tho luilding and its construction may
be sent to '�� C1.6?IL..!'.P P s S.R �• S W - l T \ 1 lt� W
\A11 -? l S co
The undersigned applicant for this building pennit 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 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 for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such sube rs, on work to performed under this
permit, as are licensed by Miami Shores Village.
Remarks �/ / / /��lC! 4 • /_ �Li.!' '
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-
t
peared
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 {-
s7t ire t
Permit No._ — � (�
Disapproved - Date
( Signed) ._.,�.. t�...
Building Inspector
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.
O.
Chairman
Member
Member
Council Approved
(Signed
19.
Amount of Permit $.
.Plan Cubage
Size of Building Lot
ead, Sworn to and Subscribed before me.
Notary Public, State of Florida
My ommission Expires
to me well known,
BOARD DATE
Member
Member ..._
Member... - _. _...__ .._. .__ .._...._ _ _..._._.._....
Date 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
•I