1175 NE 102 StApplication 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.
/LL Date .�)�7& 22_._. �. x•19..27
Owners Name and Address i . �. 1....� ... No..,f /. /. Street_ _....__ .
Registered Architect and /or Engineer b.;c I l..f/�. J :, - .. ..... ......:.....:+. -:
Name and address of licensed contractor.. U 11‘. .
Location and legal description of lot to be built on:
Lot 9 Block ( 1
/ Subdivision /
Street and Number where work is to be done )L ,(... 2.5✓. ' -
Distance to next nearest building
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT.
APPLICATION FOR BUILDING PERMIT
Building Inspect
Permit No Date
Disapproved yI Date.
(Signed) l ' 1 �) c
NOTE: A charge of $1.00 will be made for making
the Planning Board.
A re-inspection fee of $1.00 will be charged
materials and /or workmanship.
Chairman
Member
Member __... _._._._ ... - .
Council Approved
Member
Member
_ Member
Date Disapproved
0 4G,� Q &'
ti it- '. S
Read, Sworn to and Subscribed before me.
ANNINC BOARD _.. DATE
corrections or changes to this application after approval
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 his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup plenient,
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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performe under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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 stated are true.
age-
to me well known,
Notary Public, State of Florida
My Commission Expires
Date
has been obtained from
when such re- inspection is made necessary by improper notice for inspection or faulty
State w rk to be done and purpose f building (b floors) .. _
Ilg
/ ! ; ) t \ S fi r .•-- _...6■ • btltt.trhIN +Si - o AMA ) FC
New Building g Remodelin Ad ition Repairs No. of Stories
To be constructed of r 1 .V.JtAi Kind C.
f undation.... 0"...,... R St ti4'
f Covering S7 C —"
4 7
Estimated Total cost of improvements $ `� / � Amount of Permit $,. . —c
Zone cubage required .Plan Cubage
Size of Building Lot
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