465 NE 102 St (7)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby upnde for the approval of the detailed statement or tree 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, IIorid.t. and n11 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
plats and specifications must be kept at building during progress of the work.
D
Date 4P/el' L o 1971
Owner's Name and Address . 0 hN ail/0
Registered Architect and /or Engineer..
Name and address of licensed contactor .........
Location and legal description of lot to be built on:
Lot Block Subdivision
'
Street and Number where work is to be done T /
State work to be done and purpose of building (by floors) /f "T_ e- 00, 92
Disapproved
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. SS.
Before me, the undersigned authority,
peared
Building Inspector
Date.._..
(Signed)..
_ No 1 Str
PLANNING BOARD
Chair :nan ......
Member
Member ..
Council Approved Date
_.._. and for no other purpose.
New Building Remodeling Addition... Repairs No. of Stories
S
C /,) Kind of foundation Roof Covering
To be constructed of g
Estimated Total cost of improvements $ /L.- ' Amount of Permit S.... %1
Zone cubage required .Plan Cubage
Distance to next nearest building Size of Building Lot
Maxiunum 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 5 en ..
i.. The t � '`ed applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer •
ani \bur under` rr londa Workmen s Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
in tl e s cn �� the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him inspection on the site of the work such public notice
or noticcs to be oormed under this permit; and will post or cause to be posted "
permit, as as to
by the Act. The undersigned agrees to employ only such ss pntractors, on work to be performed under this
Rem - f - Miami Shores Village.
Lary 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 \,..,t says that he is the
of the above described construction, that he has carefully read t oregoing applicat m
on, and that he did sign the sae, and that all facts
therein by him stated are tr
Read, Sworn to and Subscribed before me.
Perrnit No Li Date t t-f-Xi )
Notary Public, State of Florida
My Commission Expires
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 Pl,urnir•;;
A re- m\ix•ctiorr 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.