141 NE 102 St (13)t •
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement or cue 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. ,
13 Owners Name and Address %)/9/ eS P7 661 f (4. /l Z _ No....L9.1 Street NJ ..74_2 S T'
Registered Architect and /or Engineer ,,.,, ,..••.,,,•..
f� C e s' �s 2M✓c .. Il C o 14-1 �.. S
Name and address of licensed contractor. f . � ? ms . .... ..14` -' .»._. �»._.. .�' C-le'L' Q
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 )....t.li'• ..s: •l L C ._. 6 _/ 114- Few G -e
Disapproved Date
(Signed)
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
Q4 Z 21 g23 — 2_2/ a
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof vering
0 0
Estimated Total cost of improvements $ j )1° ° Amount of Permit $. t 6
Zone cubage required plan Cubage
Distance to next nearest building.. Size of Building Lot
lfaxunum 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 crrtify 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 dement,
and has complied %%ith the provisions thereof, and will require similar compliance from all contractors or sub-co tractors 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 o e work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ntractors, on woe o be performed under this
pcnnit, as are licensed by Miami Shores Village. /
Remarks (Signe �`a�T��
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 -- —
_ 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..
Permit No `� 3 7 v Date....1� ?�s� Y Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
MyCommiuion Expires _...._...... —. �.__.�
PLANNING BOARD DATE
Chairman Member
Nferr,bcr Member —
hfembcr 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 P1, nnir.;; Board.
A re fce of $1.00 will be charged when such re inspection is made necessary by improper notice for inspectirm oe faulty
materials anti /or workmanship.
FENCE MASTEIZS INC.
11..00 Nw SJ. 1■•vvr Drive
Fiori3,3 33178
Phone 823.2210
..p1Ovcd L.
Any chnnnes micie to the fence
rikty u(::110. 11
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