860 NE 91 Terr (10)LOT �P
My Commission expires
Chairman
Member
Member
Secretary
Building Inspector
Permit No. `'4
Electrical Permit No.
Issued t
BUILDING ' PERMTT RECORD
MIAMI SHORES VILLAGE
FLORIDA
Notary Public(Signed)
PLANNING BOP_RD
DATE /
APPLICATION
Application is hereby made for the approval of the plans and
specifications herewith submitted for the building or other
sturcture herein described, This application is made in com-
pliance and conformation with the Building Ordinance of the
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 Department of
Miami Shores Village, shall be complied with, whether specified
or not.
OWNER =
ARCHITECT �� /� ���
0 Prf /2% . -'� / CONTRACTOR
BLK SUBDIVISION ;� STREET #
NEW ADDITION k REPAIRS NUMBER OF STORIES ROOF/ ;//
COST (excluding Archtitect's fee, landscaping & garage)$ / (4 i 4 /
Building to be used for ��� and no other use.
I hereby submit all the plans and specification for said buil
STATE OF FLORIDA) Signed Cif
COUNTY OF DADE )
Before me, the undersigned authority, a notary public, duly
authorized to administer oaths and take acknowledgment, personally
appeared to me well known, and
who, being by me first duly sworn, upon oath deposes and says that
he is the builder of the above described construction, that he
has read the foregoing application, and that he did sign the same,
and that facts stated by him are true. Read, Sworn and Subscribed
before me,
Cubic Feet Cubic feet required in this Block
Plu :tib Lng Permit No.
Date l% -4 7