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437 NE 102 St (16)Inspection Date Approved Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date " A/9\ OC-1 Type Insp'n -&tt 6 Ace Permit No. hp 03-/077 Name FoneV 72. Address L ' 3 7 /Vg 1 ora 57 Company Phone # a',oq Re- Insp'n Fee ❑ (/c) jam •si �� MIAMI SHORES VILLAGE 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 progress of the work. . Owner's Name and Address.. Date ry (�C �1,�.'a..` No � - -1 Stree , 1g \o L t'!�2-L � �a... -.�.. Registered Architect and /or Engineer... Name and address of licensed contractorl�Q Location and legal description of lot to be built on: New Building Remodeling.-/ STATE OF FLORIDA, COUNTY OF DADE. ss• Disapproved � Dat (Signed) - .._ 4f./�� --- Lot Block Subdivision Street and Number where work is to be done �y� 1, a- t t State work to be don and purl C S I NPAK , Ne... _ uilding 1 Addition Repairs No. of Stories and for no other purpose. To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ Amount of Permit $ 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 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all co. . ctors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspec '.n . • the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such QI • o t ac • - o work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Sig 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 5".'" � �� ��_ Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires NING BOARD DATE Chairman Member Member 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 Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.