160 NE 102 St (5)Location a d legal description of lot to be built on:
Lot �. s it .. / Block.... 4
Street and Number where work is to be done
Disapproved .... '
(Signed)
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials anti /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby mode for the approval of the detailed statement ur tore plans and specifications herewith submitted for the build •
inc 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 iuilding 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.
Date-OIL -2- 1 c1
Owner's Name and Address ... PA. . r^ A �+ S , .._ ......_._ _ No..E. �Q 0 N C Street— Q Z S'_
Fcgistercd Architect and /or Engineer . Cc � v,,. +e+•••,,,•ee..n+T • rwr
Name and address of licensed contractor 105
Date.
Building Inspector
2 i ' I�: �. c� 1 ex= ..3.30
Subdivision .6 1P 1.1 _".L __....._..2/ _l&
(coo ... ,..._..__....._ __
State work to be done and purpose of building (by floors) �, aSl o�S 'r4:: ....P
Chairman
Member
Member ..
Council Approved Date
PLANNING BOARD DATE
73
and for no other purpose.
New Bui!ding Remodeling Addition Repairs' No. of Stories _
To be constructed of Kind of foundation Roof Covering
0
Estimated Total cost of improvements $- •- .t5st..za Amount of Permit t ...IP .L..
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 pennit 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.
anti has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hint
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 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)_
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
thcrcin by him stated are true.
Permit No. ._. i� 11 Date It Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
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
I (o 0 toast