437 NE 102 St (14)Owner's Name and Address - ?U+ u `2.e17
Registered Architect and /or Engineer G O 1 1 R r V\ O'
Name and address of licensed contractor_. 9X'! 15_- e_vy.
Location and legal description of lot to built on:
Lot 11 Block i Subdivision__M\_
Street and Number where work is to be done 45/ E
State work o and purpose of building (by floors)___E_X_,.J+
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MIAMI SHORES VIL E
BUILDING INSPECTION DEPARTM EN
tre,/ APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approyal 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 progress of the work.
Date .... l Co
g_t.C'h.% CAX S_ o thw b\u t�_,1�A1�,v,1��
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,19.1.1
Street_ N E ST
and for no other purpose.
Addition Repairs No. of Stories
P e q Q si_siL 1 0 t/■
Estimated Total cost of improvements
New Building Remodeling
To be constructed of ' u h t 4 ' Kind of foundation
$ (p o o
C GVc
I herebx all the plans and specifications for said building. All notices with reference
be sent to T a y i
Roof Coverin
L AS H ALT Aci
Amount of Permit
Zone cubage required plan Cubage 4 210c) ' ,g .
Distance to next nearest building Size of Building Lot i O 0
Maximum live load to be borne by each floor _
to the building and its construction may
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 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions 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 posted 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 such subcontractors, on work to . , performed under this
permit, as are licensed by Miami Shores Village. �/
Remarks__._ ...... _____ -___ (Signed)/(/
STATE OF FLORIDA,
COUNTY OF DADE. j 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
therein by him stated are true.
Permit No._ _ Date — / Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed) _
Building Inspector
PLANNI
Chairman
Member
Member
Council Approved Date
NOTE: A charge of $1.00 will be made for making
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
OARD D E
Notary Public, State of Florida
mission Expires
Member
Member
Member
Disapproved Date
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
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