1201 NE 102 St (6)Owner's Name and Address .... Po V '' p
Registered Architect and /or Engineer
Remarks.
Chairman
Member ..
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statr:,,,r•nt us site 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 Jrtraml
Shores Village, hlnrid.t. 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 csopy of approved
plans and specifications must be kept at building during progress of the work.
Name and address of licensed contractor / fi e." — fi % ......10"f% "it. t. t ... C •
Location and legal description of lot to be built on:
Lot 1 Block Subdivision. _.....7.1.1.--.1 . 9 r e t t C
Street and Number where work is to be done..._ /.j.d L._._..� S
State work to be done and purpose of building (by floors)._!`/ C o 4. f_.._ 7f.e. r...0 TZ, d _
n ry I "' s :1 L a _.....and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of hind of foundation ....... _____ .... _ Roof Covering
Estimate Total cost of improvements $ Z C ... Amount of Permit $.
Zone cubage required __..... _... ___ __.Plan Cubage
Distance .to next nearest building _._._ _ _ Size of Building Lot. ... -__ .__ _..._.._
Maxirnurn 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 un der s ign e d 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, Prominent Supplement,
and h complied ss ith the rovisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performe under this permit; and will post or cause to be posted for 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 subcontractors, on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
STATE OF FLORIDA, 1
COUNTY OF DADE. j 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.. j
Permit No..__.. [
.. Date ` P Read, Sworn to and Subscribed before me.
Disapproved
(Signed) _
Building Inspector My Commiuion Expires
ate -...____ ..... _.._.._._...
Date ei ' / r
.19_
._..M No I .° a Street&_K _._ /0 L J"='
(Signed)
Notary Public, State of Florida
to me well known,
PLANNING BOARD..._.._... _.._._.__DATE
Member .... _ . '
Member_ ..._.._.
_...`. ._. _ ___.,...._... _ Member _ _._ _.. -- --
Council Approved . ................... ..............._..__..__- -...__ ._Date Disapproved ..._... Date
NOTE: A ch.irge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials anu /or workmanship.
BUILDING & TUNING , - AUMINISIRATIUN
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