395 NE 92 St (2)be sent to
A
Owner's Name and Address •
L8 CAT8 i N F
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 herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Registered Architect and /or Engineer /
Name and address of licensed contractor � ./ Q / /0 r C 5 4 �/ C
Location and legal description of lot to be built on:
Lot a_._ Block 5'? Subdivision
Street and Number where work is to be done ? 7 (-
State work to be done an 1 purpose of building (by floors)
and for no other purpose.
New Building Remodeling � Addition Repairs No. o Stories
To be constructed of Kind of fou�n Roof Covering / Cs4 i e' o l
'
Estimated Total cost of improvements $ 0 / ''.-- Amount of Permit $
Zone 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 p s and specifications for said building
a if .e.?.a/
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 si of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors , •o to be performed under this
permit, 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-
peared
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
therein by him stated are true. `
Permit No `Z ( Date f "� ( 1 Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Bui mg Inspi . or
Da
Chairman
Member
Member
Council Approved
BUILDING INSPECTION . PARTMENT
ULDNGPE
Cd
4,(1
f 0•
LANNING BOARD DATE
Member
Member
Member
Date Disapproved
OT
No <77-r Street
NOTE: A charge of $1.00 will be made for making
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
corrections or changes to this application after approval
Ls 03
,
11 notices with erence to ) ding end its construction may
4, ,r oa?c
to me well known,
Notary Public, State of Florida
My Commission Expires
Date
has been obtained from
for inspection or faulty
Owner's Name and Address
Registered Architect andior Engineer
Name and address of licensed contractor
Street and Number where work is to be done 3� S
MIAMI SHORES VILLAGE
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 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 regulations 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.
Koe Nate...tit 467
Location and legal d description of lot to be built on: // 9'' oG /. , y,' 7
Lot f' �'`t Block ti Subdivision V `''1 1 �� t Sta.(
NC a S7?
State work to be done and purpose of building Iby floors). state exterior colors (submit samples)
\3( few k j- C��td1
No. 3 e l 1 Street 1.)51
enitove x .s Q- Ctkk o
�[ and for no other purpose.
New Building Remodeling / _ Addition Repairs No of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ 1 4 oaf Amount of Permit S
Zone 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 plans and specifications for said building. All notices with reference to the building and its construction may be sent to
3(16 33167-
Remarks ISigned)
Date S — 3 1910
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons 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 l(uch subcorjrastors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
C IJ c°• 0 7 4
STATE OF FLORIDA
COUNTY OF DADE. ss.
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 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. Jo �` V Date 4/ � Read. Sworn to and Subscribed before me.
Disapproved _ Date
Signed
Building Inspector
Notary Public. State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $25.00 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 $25.00 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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