137 NE 92 St (7)MIAMI SHOREg
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 build-
ing 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 hereiryspecified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date
Owner's Name and Address ffo � � A. C!l C/ .f
Registered Architect and /or Engineer h 2/1 (o1
Lot Block Subdivision
Street and Number where work is to be done. __ - 9 7— ce-
State work to be done and purpose of building (by floors)._._�� 20
Da 1
>
, 19
% o
No .- -.,l. / Street. •Y ?
Read, Sworn to and Subscribed before me.
Name and address of licensed contractor.. .. F' de - d/ 0 "9/126
n co ' 6
_ J .- ?l._6 �v �'•
Location and legal description of lot to be built on: ?F( 9 7A/ / 5, �/ t 0 iG c '#c ,c'/
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foun ation Roof Covering
Estimated Total cost of improvements 0)7 0 a.__.2 a Amount of Permit $ °
Zone cubage required .Plan Cubage /s </ _ . / C, 4 i
Distance to next nearest building.__. Size of Building Lot
Maximum live load to be borne by each floor
I hereby s bmit all the plans a d specifications jor aid building. All notices with reference to the building and its construction may
be sent to h 1 (//.--.2/7- 2s" ca eti a.at J' 44 1 J � f
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 cinder 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
permit, as are licensed by Miami Shores Village. 1rr0 a 01, di rI
Remarks (Signed
) nn s �
STATE OF FLORIDA, /l7
COUNTY OF DADE. j ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 the same, and that all facts
2 Date
therein by him stated are true.
Permit No
Disapproved
Notary Public, State of Florida
(Signed)
Building Ins. ctor 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.
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement us ore plans and specifications herewith submitted for the build
it c or other structure lr}•rein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Stores Village, llnrid.tr.nd all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
pans and specifications must be kept at building during progress of the work.
Owner's Name and Address V\ C \ c7. � 4�.L =� _ No..�`� _..__. Street.L!.
Registered Architect and /or Engineer .,. ,,.....,,_.,,..•••,.- . ...,. •
Name and address of licensed contractor ..\`` \.c7. � - h\ C .�y ..............._._...._
L cation and Legal description of lot to be built on:
Lit 1 d s?Q Block ..,3 Subdivision.......... \ S _ 5 -� LI o \`\ 1
Sireet and Number where work is to be done.....)..? .7 __ \-=- 9 .al. S T __.._..__ _ _._..._.__
Slate work to be done and purpose of building (by floors) 6 I E f t 1`1 POV L Dote
BUILDING INSPECTION DEPARTMENT
and for no other purpose.
New Building Remodeling... L ` - Addition Repairs No. of Stories _
Th be constructed of Kind of foundation oof Covering
Estimated Total cost of improvements S., 1 7 C> Amount of Permit 5.N...
Tame cubage required Plan Cubage
Eistance .to next nearest building Size of Building Lot _ .......... ..................
m 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
b: 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 hips
in the work to be performed under this permit; and will post or cause to be posted for inspec ion on the site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such su• •n• actor on work to be performed under this
ponnit, as are licensed by Miami Shores Village.
Remarks (Signed)_.._.. :.
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-
pr:ared
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 the same, and that all facts
tFcrcin by him st.atted are true.
Date Read, Sworn to and Subscribed before me.
Disapproved Date.. (
Signed) Notary Public. State of Florida
Building Inspector My Commission Expires ....._..._.._.___ _
PLANNING BOARD DATE
Cirair;nan Member
NI ember Member
Member — .._.._..
N1eml�cr .. .. _ ...__
Csuncil 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
tl c 1'I. Board.
A re ,n'pection 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.