517 NE 102 StAPPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building 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 /r? e54 Iiie f .4 t l J(J #1 c 6 //it/ G /
Registered Architect and /or Engineer ! 4'S 2 PT/ r /i
Name and address of licensed contractor J4iJ 4. 7-$ l A vie 2 � � 4ri^ /, 75 5 ye4/ & 4 1-1/.4./
Location a d legal descrip of lot to b?uilt0n :
f/ 3 0 / 1 e 1 317 9 �C/�:
Lot �rj► j
/f�l tio Bl ock '
Subdivision AMP PL t4 -ti 51.) 336
Street and Number where work is to be done '( 7 ./0 cC / d 4) 51—
State work to be done and purpose of building (by floors), state exterior colors (submit samples) v /6 7 G Y G glc l / 15% // f
,J.5 tie u vEiv 17, A
Addition Repairs
New Building Remodeling
To be constructed of r4 ( 7 y 5pA A
Estimated Total cost of improvements S
Zone cubage required
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to
L *64- s i Tet OA) G 5 _ i / - a. N /
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Kind of foundation 2 / , G, 4 C /e
Size of Building Lot
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 undeyjhis permit; an will post or use to be posted for inspection
on the site of the work such public notice or notices as are required by the Act. The undersigned agr a to mploy o J such subco actors. on work be performed
under this permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLO
COUNTY OF DADE. } ss.
Before me, the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared
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.
1110
Permit No.
Disapproved
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved late Disapproved Date
NOTE: A charge of $25.00 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 $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.
Date
Date
Amount of Permit S
Roof Covering
. 37 (
E/<25
Read, Sworn to and Subscribed before me.
3 p / 7 793
Date 3 19 g
No. 5/ Street I))
No of Stories
Plan Cubage
and for no other purpose.
Notary Public. State of Florida
.Z4/
re,
Disapproved .._
(Signed)
NOTE: A charge of 51.00 will be made for
the I'Iannir.g Board.
A re-inspection fee of 51.00 will be charged
materials anti /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement us rte 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 thc Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of thc 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 progreu of the work.
Date..._I.L.rt.a. s......__..._._—.._ ». ,19.4 Q
Ov.-ncr's Name and Address.... lT... . ,a.L afrie,.. . 1. 0 Nt. .G'...5. ._. No.....15..y..._.. Street_.Ns.E_/..9..L.N..r JT•,
Registered Architect and /or Engineer . ,:.? III •••VI? •f,,.,...5,... ..,,...
ST
Name and address of licensed contractor q L -6.!A oPP 'fie Ad. =..7:- a ..^f„La . ILL--
Location and legal description of lot to be built on:
Lot Block Subdivision
N
Street and Number where work is to be done
St to work to be done and purpose of building (b floors ).. Yet. « -+ s Pr'i 'T
' F S &r.. 8. • sTR 04•,x.10
5.1..D... /3144.. AO %L..&A il .. »_.. _..__ • and for no other purpose.
Date
uilding Inspector
New Building Remodeling Addition Repairi No. of Stories
To be constructed of Kind of foundation Roof Covering
O`
Estimate Total cost of improvements $ 7 0 0
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, Penrrtnent 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 su on work to be performed under this
pcnnit, as are licensed by Miami Shores Village.
Remarks __._.__ (Signed)
STATE OF FLORIDA, 1 .
COUNTY OF DADE. j ss•
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 sta true.
Permit No 14/115 Date l5 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commiuion Expires _. »..._
PLANNING BOARD DATE
Chairman Member
Member Member
Member .. ...
Council Approved
_ .... »....... Member
to me well known,
Date Disapproved Date
making corrections or changes to this application after apprn al has been obtained fm in
when such re- Inspection is made necessary by improper notice for inspection or Isulty
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