171 NE 102 St (13)Permit No.._
Disapproved
(Signed)
MIAMI SHORES VILLAGE il l S //44
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMITfi &
Application is hereby made for the approval of the detailed statement ut Isle plans and specifications herewith submitted for the build •
in or other structure }wren d 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 thc Building Division of Miami Shores Village shall be complied with, whether herein specified Of not. A copy of approved
plans and specifications must be kept at building during progress of the work.
191g3
Owner's Name and Address onin . ?f — — Nel Street—ekt.ae
Registered Architect and/or Engineer MIT el.• • ****
Name and address of licensed contractor .....
Location and legal description of lot to be built on:
Lot Block Subdivision - Y.J.C.
Street and Number where work is to be done / 7L / 3 #:
State work to be done and purpose of building (by floors) .i.eatittii .15447 yrtra-s..
1/4 Ca$
peared
Date 3 tr..3 Read, Sworn to and Subscribed before me.
Date
Building Inspector
Notary Public, State of Florida
My Commission Expires
31 ?
and for no other purpose.
New Bui!ding Remodeling Addition Repairs No. of Stories
To be constructed of Kin&of oundation Roof Covering
Estimated Total cost of improvements S. Amount of Permit a,:5 0
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 Flonda NVorkinen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied ss ith the provisions thereof, and will require similar compliance From all contractors or sub-contractors employed by him
in the 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 noticcs as arc required by the Act. The undersigned agrees to employ only such subcontractor), on ork to be performed under this
pennit, as are licensed by Miami Shores Village. fia • " 3 4.14 •
Remarks (Signed)- -- "- 1 "-- 0 •
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
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 re true.
PLANNING BOARD DATE
Chairman Member
Merr.ber 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 Planning lluard.
A re-M.1)(1.6°n fee of 31.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials anti/or workmanship.