490 NE 102 St (12)442
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Buildin: Inspection Request
Date
/I
Type Insp'n
No. / Or oo o 4- /351
Name
Address 4-50 / O
Company (005/ Phone # eL = 060 I
Inspection Date r< IkS
Approved
Correction ? C i f
Re- Insp'n Fee ❑
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.
Owner's Name and Address... ' _` _' _ J r E-rc..
Registered Architect and /or Engineer._. _ . .
Name and address of licensed contractor.
Location and legal description of lot to be built on:
7185 N. W. 26th AVENUE
Lot.. t $s ,..r Block Subdivision MIAMI, FLORIDA 33147
490 N. E_,_I_ 2-uD Sr.
I ,� r l � � L � p �� r - l
State work to be done and purpose of building (by floors)_. _ C�- 1a_ lY\___ll!'n_z_____T_e.nce__._ QA- - T u 1'tf l-;
Street and Number where work is to be done
New Building Remodeling
To be constructed of Kind of foundation
oa
Estimated Total cost of improvements $ ' 7 S v 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 foi said building. All notices with reference to the building and its construction may
be sent to_ _.G t G. - ` _ l . l . Cg: _ C ■ (Ato • 71 P.5 . w . „ �
The undersigned applicant for this building permit doc hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act, being Sec :ion 5966, Compiled General Laws of Florida, Pennanent 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 subcojttj tors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
Building Insp: ctor
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date.
LANNING BOARD.. __
Chainnan _
Member
Member
Council Approved .. _.. _ _Date
NOTE: A charge of $1.00 will be made for
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
Date vANJ • 29 , 19 409
. No - -- Street- - - -. -- .• -
Ill Lbtl'd L }ICE
and for no other purpose.
Addition Repairs No. of Stories
Roof Covering_
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, rho 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 . / ° 0 �°
Disapproved L
(Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires_
DATE
Member
Member
Member ...__._ .
Disapproved
Date
making 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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