152 NE 92 St (7)11A 1`'1 SHORES V LL GEE
BUILDIN INSPECTION DEPARTMEN
APPLLOCAT9®N F ® :AJILDONG PER err
Application is hereby made for the approval of the det, iled statemen of the plans and specifications herewith submitted for the build-
ing or o h. - , :ructure her i described. This .t-1 licatic is made in compliance and con •o•m ty w.th the Building Ordinance of Mia
Shores Village, or da, and all pro. isions of the Laws tf the Statu of 1•krid. all o d nances ,,f Mi m Shores Village and all rules and
regu'a ■ion. of the Building Div.. i of .lam- Shop iilage h ,e , o. ipl.ed with, whether herein specified or not. A copy of approved
plans and specificati m must be ket•. at burtding durin progress of tl.e wcrk.
Date._ P , 19 01
Owner' Name and Address e a $ e �, 4 iz No ./ �___,v' Street_. ___ 9. z c
Registered Architect and /or Engineer._. Q ___
Name nd address of licensed contractor e 9itt/_L ___ l��a_�[B S te .. /�vc + 0591 el.' _- / 4 144 R
Location and legal description of lot to be built on:
Lot.._. Block _.__. Subdivision
Street and Number where work is to be done_ __/_ 1 .. "—'
State work to be done and purpose of building (by floors) 4 43 -_�' 02.05!_z_4/7--
,S r9_Ae -.XL •94 ��� 9 ? � c° ,5./r/ e g-
_ and for no other purpose.
New Building. Remodeling__ ____ _ ._. Addition____ ____ ___ _____ _ Repairs_ .' _ _ No. of Stories.
To be constructed of _ _ Kind of foundation Roof Cov ring__
Estimated ^..tal cost of improvements $__ ; �. Amount c` Permit $ .. ._ .
Zone cubage required_ __. _ _Plan Cubage
Distance to next nearest building__ _ _ _ ___Size of Building Lot
Maximum live load to be borne by each floor.
hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be seat to
The unde signed appli ant for th's budding permit does hereby certify . ?fat he understands and accepts his ,•bligations as an employer
of 1• bor under he Florida Workmen's Compensation Act bong S - .-tion 5966 Coi p led Gen al Laws of Florida P r anon. S :ipplt vent.
and h s compl ed wrth he prov•:ions thereof, and will require s•milar commfance from all contractors or sub - contractors emplo .ed by him
in the wok to be p rf• under th ;s pern lit. and • ill post or cause to be posted for inspection on the site of the work su :h public noti. e
or .otues as are requir• d by the Act. The u..ch r• ign. d agrees to employ only such abcontr. ctors, on work to be perform d . der this
permit as are licensed by M ami Shores N i1 : ge. •
Remarks__ (Signed)
STATE OF FLORIDA, �-
COUNTY OF DADE. $ ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths :.nd take acknowledgments, personally .'p-
peared _. ___ __
.to me well known,
and who, being by me first d. ly sworn, upon oath deposes and says that he is the ._
of th abov described ••istruction t. h has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie.
Permit No _ _.__ Date ___. Read, Sworn to and Subscribed before me.
Disapproved Date_
( Signed)
Building Inspector My Com:nission Expires
Notary Public State of Florida
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 fti -r approval h is been obtained from
the Plans ng Board
A re-inspection fee of $1.00 will be charged when such re- inspection is male necessary by improper notice for inspe :•t'or or fai'ty
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n
< Permit No.
Name
— Address
Company
Phone #
For Inspector:
Correction
Time
Re- Insp'n Fee ❑
O Lzkyy\ QA
--2 oc) -s 17
O " Name & Dat