395 NE 92 St (3)r- ..
Owner's Name and Address
Location and legal description of lot to be built on:
New Building —.
To be constructed of
STATE OF FLORIDA,
COUNTY OF DADE. �'
Council Approved
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 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.
Registered Architect and /or Engineer
•
Name and address of licensed contractor r' -
Lot _��� 6 - ' Block_ L' _ —_ Subdivision '
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
1944
r ` '' Street__
. __and for no other purpose.
Remodeling_________ ___ Addition__ Repairs ' `"' No. of Stories_
Kind of foundation
p f d -, !�
Estimated Total cost of improvements $ ______Amount of Permit $
Zone cubage required __flan Cubage
Distance to next nearest building Size of Building Lot
'Roof Covering_
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
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 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) "r f
PLANNING BOARD DATE
Chairman Member
Member Member —
Member Member
Date Disapproved
Notary Public, State of Florida
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.__ dL _/ Date Read, Sworn to and Subscribed before me.
Disapproved _—____________________ —___ Date
(Signed) - -- — — Building Ittspector My Commission Expires
_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.