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268 NE 102 St (6)Permit No Disapproved (Signed) APPLICATION FOR BUILDING PERMIT Application is hereby mode for the approval of the detailed statement of we 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 'tluilsling Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved pliins and specifications must be kept at building during progress of the work. Owner's Name and Address Registered Architect and /or lyngincer Name and address of licensed contractor Location and legal description of lot to be built on: MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT /o ` e`/ Date Ncw Building Remodeling Addition To be constructed of C 6 5 Kind of foundation Estimated Total cost of improvements $ Zone cubage required Distance to next nearest building.. Cari e //2 e/ No 24Q...._... street.... A/ / 07- 4z'JO (J t ursc H.KA4) / ' eg r, •„ C „ee., „,,.,,-., .... ..7 nez-e -ch , ff osr e- a , f, Lot Block Subdivision Street and Number where work is to be done PiF” /" to 2- sT State work to be done and purpose of building (by floors) 2.01 Vt ( r az Roof Covering Amount of Permit S. ''4_ plan Cubage 6 Size of Building Lot and for no other purpose. Repairs No. of Stories 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 Lihur under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied ss ith the lxuvisions thereof, and will require similar compliance from all ,.'tractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for .n on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such s . actors, on work to be performed under this pcnnit, as are licensed by 141iami 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 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 m e. I'M � A/ Z�/ Date Read, Sworn to and Subscribed before me. to me well known, Notary Public, State of Florida Building Inspector My Commission Expires Chairman Member Member .. Council Approved Date PLANNING BOARD DATE Member Member Member _ .._..... 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 Plannir,;; Bo.trd. A re- inspection Ice of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspertirm or faulty materials and/or workmanship.