155 NE 92 St (9)'
Application is hereby made for the approval of the detailed statement of the and herewith ri
pp p p bmitted 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 cif 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.
Owner's Name and Address ( .. / . C 4 t 9 C L
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lott' f>_<J pZ/ Block .2 3
Street and Number where work is to be done _si 6
State work to be done and purpose of building (by floors)
Estimated Total cost of improvements $
STATE OF FLORIDA,
COUNTY OF DADE. ss.
MIAMI SH is RES VILLAGE
BUILDING INSPECTION DEPARTMENT
'APPLICATION FOR BUILDING PERMIT 0'
Building Inspector
Subdivision
Chairman
Member
✓7 - 02 - /
New Building " Remodeling Addition
To be constnicted of Kind f o nd tion
_Amount of Permit $
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
PLANNING BOARD DATE
Date . e C 7r `/ ,190-/
No °7 ' 3 Street __ /) e / oa ��tC7'
Repairs
/ 8-0 -'
and for no other purpose.
No. of Stories O N N
overing
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_e// S" A/ 4" / D 47 f'7
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 sre required by the Act. The undersigned agrees to employ only such subcontr . ors, on work to pelf med under this
permit, as are licensed by Miami Shores Village. _
Remarks ( Signed) _ _
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 cescribed construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No._ c � '- Date Read, Sworn to and Subscribed before me.
Disapproved Date
(Signed)
Notary Public, State of Florida
My Commission Expires
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 Beard.
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.
4
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