1201 NE 102 St (5)Application is hereby made for the approyal of the detailed statement or the plans and specifications herewith submitted for the build •
in 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. .
Owner's Name and Address f ' 04.,/ . . :. _ (42 /0— i _
Registered Architect and /or Engineer ...,, ,n•••ensmnnsrw.•rn :nn,ennn.
Name and address of licensed contractorl� ,il T�'� / w
Location and lc al description of lot to be built n: /�
Lot Block built
Subdivision. le
Street and Number where work is to be done !` ?L
St to work to be done and purpose of building (by floors).... -S
Estimated Total cost of improvements $
STATE OF FLORIDA, 1 .
COUNTY OF DADE. J ss•
Before me, the undersigned authority, a t
geared .... �� yJ e rz•
Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
-7
y ...s n tQ 0Jo
New Building Remodeling Addition Repairs
To be constructed of Kind of foundation
(Signed)
etvdA)
a
and for no other purpose.
No. of Stories
Covering
sys
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 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 Supplement,
and has complied w 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 uch public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors work to� rmed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks
/ote5 yt lq/
no y public, duly authorized to administer oaths and take acknowledgments, personally ap-
r r to a well own,
and who, being by me first duly sworn, upon oath deposes and says that he is the... kne h.4.(1.! ? G r
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, d that all facts
therein by him stated are true..
Permit No.... JL Date ....! 419) ..'!`' d, Sw•rn to an
Date.
Building Inspector
PLANNING BOARD DATE
Chairman Member
Member Member
Member .. ... _ .....__....._..._._...._....._ Member
Council Approved Date 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 PI,nnir ):eased.
A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials anti /or workmanship.
Notary Public, 6 '4MM' . a Stai&s o i
My Commission EiOres 'fit. 4,e 1993
My Commission Expires3044...:' ..1 yraad..
c?2
Owner's Name and Address..
To be constructed of Kind of foundation
Estimated Total cost of improvements $
Building ector
Chairman
Member
Member .
Council Approved Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will he charged
materials and /or workmanship.
MIAMI SHOR VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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.
Registered Architect and /or Engineer II
Name and address of licensed contractot l .
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done /�%
State work to be done and purpose of; building (by floors) ' - ter=
Date
Street �
Roof Covering
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
Amount of Permit $
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 su . i all the phi s and ications or said bui ding. All ides with reference to the building and its con true o may
be sent t. .___
• ate
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, Pennanent 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 insp ection on the s' e of the work ch public notice
or notices as are required by the Act. The undersigned agrees to employ only such subs trac .rs, on -.rk o bp''pkyf under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed). I
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-
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. G
Permit No' Date 7 ° ( Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Member
Member
Member
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