816 NE 91 Terr (10)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION 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 regula-
tions 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.
19-
Owner's Name and Address 1H J • Ft 5 N 13 FAG ice No._— - --_ Street_ 27 c ?5_r,lhar J= —
Registered Architect and /or Engineer_____ — Name and address of licensed contractor D R
Location'and legal description of lot to be built on:
Lot O E 1aP f Block__ —__ —__ Subdivision _G Q L D..E2J G.aLE ' RA._ 1 Dt •
Street and Number where work is to be done
(
State work to be done and purpose of building (by floors) �i 0° �,
`.� r 5! T(C >1_LF F r - J- iL. \' r-,v A Lj JC
and for no other purpose.
New Building_____ — _______ Remodeling_________ Addition_ Repairs No. of Stories___ _ __________
To be constructed of____c_IL S__ —___ Kind of foundation G 6 N S_____ Roof Covering. LL k —E
q 5-'-`' / �{
®
Estimated Total cost of improvements $_____ — !- O 0 O —__ — Amount of Permit $ �'
Zone cubage required 1 62 t 5 0 O Plan Cubagei —d _� �JL __ — _____
Distance to next nearest building Size of Building Lot 2 5 X 1 4. D
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said b t 'Itg. 1 notices wit�h reference to the building JO its construction may
be sent to N �( 1 P. F H Fa c_ J s l� rS nZ 7 9 ! 1- co' pi l aryl 1 /
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, 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 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 subcor}tractor , on }vorj to be e� rnied under this
Remarks (Signed) U.' .-' r '4
permit, as are licensed by Miami Shores Village.
STATE OF FLORIDA, 1 u.
COUNTY OF DADE. f
appeared
Before me, the and rs': �d authority, a nearary pub ic, duly authorized to administer oaths and take acknowledgments,. personally
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 th. same, and that all facts
therein by him statgd are true. .� / 9_2 Date / C
Permit No —
Disapproved
(Signed) _—
Building Inspector
Date
Rea • worn to a d Subscribed before me.
Notary Public( —State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member 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- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
/11/