550 NE 102 St (3)fko zsi.i9
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby erode for the approval 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.
DEAN R. CLAUSSEN
CIIAS 1 ikEL
Registered Architect and /or Engineer L,.... .,. ,...,,..,,-I,-- I...-- ,•,,,.,,,,
X DEAN R CLAUSSEN
Owner's Name and Address
Name and address of licensed contactor
SAME AS ABOVE
Subdivision M......S.A .... SECTION ... ._ _....._._.........
650 N EE 102 ST 1 4, 1 ,, .._..__
State work to be done and purpose of building (by floors) NEW SINGLE FAMILY RES -
Location and legal description of lot to be built on:
Lot 6 & E ....7.. Block 94
Street and Number where work is to be done
and for no other purpose.
New Building X Remodeling Addition Repairs OXIe _
To be constructed o CBS Kind of foundation
& STEEL
M Roof Covering
do
Estimated Total cost of improvements $ 30 s 000 00 Amount of Permit S.- .
til
Zone cubage required plan Cubage Z
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Disapproved ..
(Signed)
10..�_.�..�... Date
Wtf�
Building Inspector
C �t`;r�ri FI HcD
Ft 00`R El_EVFlTION
.fi.rnber
M ember
Council Approved
l% P1 nrii :� J;rge- of= S+1
t :(y
- - -- -
;-:A:;tu.=i.iisprction fee of Sl�i
m ccrials andJOf 145nat#P -
MIAMI SHORES VILLAGE
SEPT 5, 1978
_ No 540 __. Street.. GRAND.- .C.O.NCOURSE
No. of Stories
T ILE
Notary Public, State of Florida
My Commission Expires
Distance to next nearest building Size of Building Lot 75x115
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 Libor under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Sup leinent,
and has complied with the rovisions 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 'r inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only s r ubcontractors, on work to performed under this
pennit, as are licensed by Miami Shores Village. // ' --1
Remarks... (Signe• L,. --- &t ti . _
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 carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. yy
Permit No. Date..i�.i'..� Read, Sworn to and Subscribed before me.
—PLANNING,. OARD DATE
Member
Member
Member
Date Disapproved Date
1 1 lie ire do Eoi`-r raking corrections or changes to this application after approval has hecn obtained from
ill be charged 4hen such re- inspection is made necessary by improper notice for inspection or faulty
c i::ii icts
'2