150 NE 102 St (5)Owner's Name and Address 3 Afa e ,.
Registered Architect and /or Engineer
Name and address of licensed contractor
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statc,,.e•nt or rile plans and specifications herewith submitted for the build
ine or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Miami
Shores Vin are, 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 ifuil.ling Division of Miami Shores Villme shall be complied with, wbether herein specified or not A copy of approved
plans and specifications must bc kept at building during progress of the work.
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ro n r - • • •�n • •.... • ,. r. m! • roar- -r.e esre. ar- �.: .
Location and legal description of lot to be built on: S R L /
Lot ' . a ) Block Subdivision.__ API i 4 M t 1 N • A e 1 /q or) A 7 ^ .
Street and Number where work is to be done c / O L 4
State work to be done and purpose of building by floors )....__ -._/ Ai .:I ' /i 7 tit o 4p4, ,A cc.
F r _. L ! 1 s s P c o .. t. e o 4 ._..... L• !vim.. and for no other purpose.
Ncw Building Remodeling Addition Repairs No. of Stories .... —
To be constructed of Kind of foundation oof Covering
Estimated Total cost of improvements $ 1 /1 I? Amount of Permit S.. -
Zone cubage required _._._.._....Plan Cubage
Distance .to next newest 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 un,irr icord applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of Libor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Perinxnent Srrplileinent,
a nd h.rs complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by Trim
:n tl:c work to bc 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 arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks _ _.... ,_ _ —_ — —_ (Signed) aEe
STATE OF FLORIDA,
COUNTY OF DADE. i 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 refully read the foregoing application, and that he did sign the same, and that all facts
therein by him matt aarbt 4
Permit No /V l . .- -_.... ...�_._.__..�
Disapproved ..
(Signed)
�.. Date
Date.
Building Inspector
Read, Sworn to and Subscribed before tee.
PLANNING BOARD _. __._._DATE
Chairman Member .._.w
Member Member _._._.... — .—
Member _.._._....._..._. —...._ Member
Council Approved .___....Date Disapproved
to me well known,
Notary Public, State of Florida
My Commiuion Expires
Date
NOTE: A charge of $1.00 will be made for making co.Tections oe changes to this application after approval has kern obtained from
the Plannir.;; liu.rrd.
A re•in•pr•ution fee of $L00 will be charged when such re- inspection is mods necessary by Improper notice for inspection or faulty
materials anu /or workmanship.
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