374 NE 92 St (11)l
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STATE OF FLORIDA,
COUNTY OF DADE.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Applicationois hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
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 regula-
tions of 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.
Street and Number w ere work is to be done
State work to be done and purpose of building (by floors)
Disapproved Date
(Signed)
Date_
Building Inspector My Commission Expires
No._ Street
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Locatiot( legal description of lot to be built on:
Loti _ Block eier
,,374 1c _cQa
fir �f y
191'
/ __and for no other purpose.
New Building_ ___Y —___ Remodeling_ __________ Addition_ Repairs N off Stories_______ —__
To be constructed of _ i_l__ __ Kind of foundation - - - -_- P'' 5 overinS_cb.
Estimated Total cost of improvements $ 10, 0 &_U __Amount of Permit $_ - _
._'
Zone cubage required z �_ Plan Cubage ® 3,5--- ;
.2__ ____�_��_ :
Size of Building Lot . / »
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specificatio s ff�said building. All notices with reference to the building and its construction may
be sent to 4 ' 9
The undersigned applicant for this building permit does hereby certify that be 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 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.
Remarks (Signed)
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved, Date Disapproved
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
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 be 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._ Date Read, Sworn to and Subscribed before me.
-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.
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