517 NE 102 St (13)Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision.
Street and Number where work is to be done.N7 ..
O cwork , done and pu os 'of building pb floo s)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
.Application is hereby umde for the approval of the detailed statement ut we 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..
Owner's Name and Address ........ .... _.. _ No... ,6-1 7 .. Street
Re Architect and /or iineer.... • ...•.., {� ,n ,., , ..•• -. .9199991, •. . -.1
oar -efiSt- _�._....._._.........._
and for no other purpose.
New sui!ding Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foe tion p Roof / Covering
Estimated Total cost of improvements $ 3Q.t i Amount of Permit S......1 (L
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 perinit does hereby certify that he understands and accepts his obligations as an employer
of Luber under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied ssitlr 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 b for insp ion on the site of . work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subco . ctor on •rk performed under this
permit, as are licensed by Miami Shores Village.
Remuks (Sig
STATE OF FLORIDA,
COUNTY OF DADE. 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 caref lly read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are e. L�
Permit No..... Date ..q r .........._._ Read, Sworn to and Subscribed before me.
Disapproved
( Signed)
Date
Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member .. .. Member
Council Approved Date Disapproved Date
NOTE: A charge of S1.00 will be made for making corrections or changes to this application after approval has been obtained from
the ]'L Board.
A re inspection fce of 51.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.