541 NE 102 St (10)Application is hereby made for the approval of the detailed statement or 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
Shorts 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 he i3uilcling 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.
.r /�,� n ' D , _ _ _ate•• ∎•1 2 ....?..... ..._._._...__...... ......... ,
Owner's Name and Address .... 0 . ./4-!SZ.P_ ...P..ot�.!✓�' r' -tal.0 .. _ No.... .1�./ ......... Street. E ./O 2. 5
Registered Architect and /or Engineer . .:., ...••• .................•,..,, .1,,11 .
Name and address of licensed contractor ,Fl 6 /QJ' . /e /.:.... 71 _`-'.�.: & 3Q /eL) f1 f/1 ?/ 3 3/5 5
Location j4. //and leg 1 description of lot to be blip:
Lot... .:li:.L./ ... Block Subdivision. ,A412 P.)- c_!" # `"' .LL j,1- ‘ 7 7 . `7/1 7
Street and Number where work is to be done -, IQ .... ..+Fr._.. z 12_ £.r........._..
State work to be done and purposc of building (by floors).....h.44 Q.N._ Jr $ VI //J _he S .Y S ren
1p K r. eA1 .... AND...prie:?`z,dQ,e.K.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation . Roo vering
Estimate . Total cost of improvements $ .i.!•
. Amount of Permit $. 6 i
Zone cubage required plan Cubage
Distance .to next nearest building Size of Building Lot
Miaxiunum 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.. ,e,.1J,,.t° 6 A a C Q eio. . - 7111
The undersigned applicant for this building perinit does hereby certify that he understands and accepts his obligations as an employer
of Labor under the Florida %Vorkinen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Sup m
cleent,
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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks (Signed)
CA CO 71/- 74
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 •2-e' )6
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 `fame, and that all facts
therein by him stated are e. v
Permit No .._ 1l J � c Date �� 1 � "o Read, Sworn to n • /
4 Date ______.,....._
i . i�
Notary Public, Stat;o ..
NAT 'Y PUBLIC STAPE OF FLORIDA
Disapproved
Building Inspector My Commission Expires.... A4y tt�uc�r4r.,«,..... ».,.. ... _�_. BONDED THRU GENERAL INSURANCE UND
PLANNING BOARD DATE
Chairman Member
Member _ Member
Miembcr 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 fee of 31.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty
materials and /or workmanship.
,'f 7///
and for no other purpose.
to me well known,