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76 NE 102 St (7)Application is hereby u►nde for the approval of the detailed statement in 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, florid.►. 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 . Ch"le kJ. J _ No.7�.. & i Street.,�.Q»�� . Si &r Re Architect and /or Engineer Name and address of licensed conicactor...G.11.?..U7fi .4:1..7L2F P0 ! v.. =.. ._......... ' J"1 J '( • Location and legal difcription of lot to be built on: Lot.! �d C EC-CA-1 2i *y f�-t �v D evIrr = 5700 N_ W 7 ./9 _ .-i% / -7 i 1 0 .. /.1....x...7 Block 1� Street and Number where work is to be done _..! �!i :.. -... ... c C� 6("--1 State work to be done' and purpose of building (by Q r BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT and for no other purpose. Ncw Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Amount of Permit 3....1 c1"2 1 W 4 2. — Zone cubage required Plan Cubage Distance .to next nearest building. .t 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 and ersigr,cd 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 5'966, Compiled General Laws of Florida, Permanent Supplement, and has complied %tith 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 ' nspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such s}t o ntractors, on work to be performed under this pcnnit, as are licensed by Miami Shores Village. (V/ Rem.uks (Signed 23 �� ° Estimate Total cost of improvements � S © / 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 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 fads therein by him stated are true. e. a /' k Date ! Permit No Disapproved (Signed) Building Inspector Chairman \1crr,ber Member .. _....._......_..._._...._.....» Council Approved Date MIAMI SHORES VILLAGE Subdivision �.. al.. /.�. AP //...-/A Read, &worn to and Subscribed before me. PLANNING BOARD DATE Date r } ` " / ....190 tC —....to me sve known, Notary tli_..S 14171"fl'? "'�r°t-. N Public, State of Ffo�tt�si COMMISSION EXPIRES JULY 25 W87 My Commiuion Expires S E1:AL.AAiSjJRAN F tND Member ......._ ................ ......._._...._...._......... ». »sass »._ Member ......._.... » ». _..._ Member Disapproved Date NOTE: A c•h.irge of $1.00 will be made for making corrections or changes to this application after approval has hem obtained from the Planning Huard. A re•ui.peetion fee of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty materials anti /or workmanship.