137 NE 92 St (6)Owner's Name and Address . l.rlllN •
;Street and Number where work is to be done
:Estimated Total cost of improvements $ f 0 0 o D
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING
Application is hereby wade 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
;ihores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
•egulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
?tans and specifications must be kept at building during progress of the work.
Registered Architect and /or Engineer
:v'ame and address of licensed contractor E' C-- I) 7°
Location and legal description of lot to be built on:
: Block Subdivision
q s
;state work to be done and purpose of building (by floors)
Date ._ _ ,19 7 .
L/Z-/ No ... L..3. ..) e - 2r..... o _% -
✓22.. 1 q t,^o.-1--oC-- - e - — Jam.
iot
ERMIT
New Building Remodeling Addition Repairs No. of Stories
'ro be constructed of Kind of foundation Roof Covering
Amount of Permit $.
:;one 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
)e 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,
ind has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
:n 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
, )r notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
?ennit, as are licensed by Miami Shores Village. ,Q� (J ,,
Remarks _ . --- -- -- ( Signed) _..._ : `
� '-r••t� `�' l 0 A- 4, Q
STATE OF FLORIDA,
2OUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per ap-
?eared
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
:herein by him stated are true.
Permit No.-_____ .. Date n � -: Read, Sworn to and Subscribed before me.
Disapproved
;Signed)
Notary Public, State of Florida
for no other purpose.
to me well known,
Building Inspector / 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 en faulty
materials and/or workmanship.