410 NE 102 St (3)7_5 7- o
Application is hereby unndc for the approval of the detailed statement us me 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 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.
_
Owrtcr's Name and Address Q6.�. f E _ No.. ... Street_....
R egistered Architect and /or Engineer .,,,. ..... ..............•........C..,..
Name and address of licensed contractor..../6s% G._.c tt2. ,t E ... . . _._..» »....».... _ ..............................
Location and legal description of lot to be built on:
Lot /J /Q Block 9/ Subdivision....?
Street and Number where work is to be done 4/0._ Nt C �.. ./.°�• __: .... _.._..__ ..._.
o work to be done and purpose of building (by floors) ,1.» __ »..._...__.
&.11 F V 7 9 L . Ori c ^ f r� J fGG �I/E cv
." .N..L.... GV /ti.,Q.6 s y�4Ga �/�A� and for no other purpose.
Ncw Bui!ding Remodeling Addition Repairs No. of Stories
To be constructed of ' Kind of foundation
/ Roof Cov
Estimated Total cost of improvements j ` 3 �'�' U Amount of Permit S. f V `
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 Florida Workmen's Compensation Act, being Section 59G6, Compiled General Laws of Florida, Permanent Snp pleutent,
and has complied with the previsions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be p• ed for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only su ubcontractors, on wo . be • domed under this
permit, as are licensed by Miami Shores Village.
Remarks _ (Signed)
STATE OF FLORIDA, i
COUNTY OF DADE. s
APPLICATION FOR BUILDING PERMIT
MIAMI SHORES VILLAGE
Building Inspector
BUILDING INSPECTION DEPARTMENT
pelted
ring
a
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally op-
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 caref}rlly reed the foregoing application, and that he did sign the same. and that all facts
therein by him stated are true..
Permit No. a. 3 Date 7 /7l , �i /v Read, Sworn to and Subscribed before me.
Disapproved ! :.....�.,.... Date
(Signed)
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairnan Member —
\Icrr.ber Member
Member .. ... Member ...._
Council Approved Date Disapproved Date
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval has been obtained fmrn
the I'Lmnir,;; Board.
A re-inspection fee of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the 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 p *grass of the work.
.
Owner's Name and Address ... 4 o._._ „,,, „ „._..... Street__.
Registered Architect and /or Enginucr
Name and address of licensed contractor i:. o-tg-
New Budding Remodeling Addition
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Building Inspector
Chairman
Member ..__.
Member
Council Approved
MIAMI SHORES VILLAGE
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of 51.00 will be charged
materials and /or workmanship.
(Signed)
.._. . . ... ..T ..... . ... .. .. _...._..__ ..
Repairs
PLANNING BOARD _.._ DATE
Membcr
Member..--- .._..._...__...._..__
Date Disapproved
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done r. ®.___ ./ e
State work to be done and purpose of building (by floors). ./d/ /-1 6.1.t .S.2._,, #ae oq
_._ . _... .s%s d1 At
To be constructed of Kind of ,foundationf Covering
Estimated Total cost of improvements $ � amount of Permit d
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 of labor under the Florida Workmen's pennit does hereby certify that he understands and accepts his obligations as an employer
and has complied with the provisions thereof, Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
in the work to be performed under this permit; d will require similar compliance from all contractors or sub - contractors employed by him
or notices as arc required by the Act. The and will post or cause to be posted for inspection on the site of the work such public notice
permit, as are licensed by Miami Shores Village.
undersigned agrees to employ only such subcontractors, on work to be performed under this
Remarks
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
Permit No._.__.._ Date . ......... ...._._._._..._._._ Read, Sworn to and Subscribed before me.
Disapproved _ Date.
(Signed)
Notary Public, State of Florida
My Commission Expires
making corrections or changes to this application after approval
when such re- inspection is made necessary by improper notice
and for no other purpose.
No of Stories
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.
Member ...._
Date
has been obtained from
for inspection or faulty
a.
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