825 NE 91 Terr (12)1
MIAMI SHORES VILLAGE x`30 -1/J/
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby umde for the approval of the detailed state:mene ur we plans and specifications herewith submitted for the build
in 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.
,11
Owner's Name and Address H aGPe.g.C.1CY No. oZ,s� .._ . Street e..�1: ...._
Registered Architect and /or Engineer tl . ' . .,. •* / ..,,. ® r..�,....,,. ,.,. _,.
Name and address of licensed contractor '��._.... �.. ! ..'......1...•�... . s.- 111 - 1Q.! e.".""
Location and legal description of lot to be built on: I Je� /�
Lot / � ..cf' )9'
4 Block Subdivi on. ... 1- c .1 . t ._.. ivfm
Street and Number where work is to be done c�_... — -.L — -- •-- •--- ••••• •_ - - --
State work to be done and purpose of building (by floors)
Chairman
Mcrr,ber
Member ..
Council Approved
NOTE: A charge of $1.00 will be made for
the I'I,rnnir.;; Board.
A re inspection fee of $1.00 will be charged
materials and /or workmanship.
Date
Remarks — _. —.._._ (Signed)..;
c : n.t e le P 7 .71_
and for no other purpose.
New 'ng Remodeling Addition L..l Repairs
-Feat
To be constructed of C.. / L Kind of foundation Q. --Roof vering
Estimated Total cost of improvements S Amount of Permit S. 40
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 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 subcontractors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
No. of Stories
peared
PLANNING BOARD DATE
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorizcd to administer oaths and take acknowledgments, personally ap-
Notary Public, State of Florida
My Commission Expires
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 true.
Date //, Read, Sworn to and Subscribed before me.
ti
Disapproved \.. 7'a at
(Signed)
Building Inspector
Member
Member
Member
Date Disapproved .
making corrections or changes to this application after approval has been obtained fmtn
when such re- inspection is made necessary by Improper notice for inspection or faulty
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belief. There are no encroachments
R EGISTERED LAND SURVEYOR 10
STATE OF FLORIDA -
LOCATED IN —
MIAMI SHORES' VI LLACIE
DADE COUNTY, FLORIDA.
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su -.:9PNI1BER 68-8-81
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SURVEY OF
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sUeDiVisioN GOI,j)KN GATE PAIVC ADDITION
According To The Plat Thereof As Recorded In Plat Book No. 6 At Pigs No 110
Publlo Records GI DADE • County, Florida iiaCierBg' #11376
caw Decaaber 1941 1968 ron_1211111122a.tIgrztlaaaLshgreaLyia. a
1 HEREBY CERTIFY that the attached
sketch represents a recent survey ade
under my direction, end Is true and cor-
rect to the best of my knowledge and
belief. There are no encroachments.
R GISTEREb LAND SURVEYOR 1060
STATE OF FLORIDA
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LOCATED IN:
MIAMI SHORES VILLAGE,
DADE COUNTY, FLQRIDA.
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