420 NE 92 St (11)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.
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Owner's Name and Address No.
Registered Architect andior Engineer
Name and address of licensed contractor
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Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
New Building Remodeling
Subdivision ag-Q/
Addition Repairs
Remarks (Signed)
No. of Stories
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
9�- rP 7
Date / ` � i f 19 S a
Street ist c /F ° ` d 1 •
6 Z.
State work to be done and purpose of building (by floors), state exterior colors (submit samples)
C o e.S?rea t�fi ow- e (3C) !re/' fu t.m. °J ,e -SA.4. n hc._c- As-!
4i
V
i! 2r c . 5 4 � 'ell
1Y 1 and for o other p pose.
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements S . U1• ' 4 Amount of Hermit 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
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 a to emp .y ., such subcontractors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
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 foregoin application, and that he did sign the same, and that all facts therein by him stated are true.
Permit No. r " / 1 ) Date I • Read. Sworn to and Subscribed before me.
Disapproved \ \ Date
(Signed) ` � ' + ,
Notary Public, State of Florida
Building Inspector 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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_ LOCATION _MAP
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SKETCH OF SURVEY
SURVEY: Of Lot 9 and the East 40 feet of Lot 10, of Block 49, of "MIAMI
SHORES SECTION NO. 2 ", according to the Plat thereof recorded in Plat
Book .10 at Page 37 of the Public Records of Dade County, Florida, lying
and being in the Village of Miami Shores, Florida.
Containing 1.1,546 square feet of land, more or less.
ORDER NO. 9098 DATE: April 27, 1988
Field Book 3,19, Page 39 SCALE: As shown
WE HEREBY. CERTIFY : - that the attached SKETCH OF SURVEY is true and correct
to -the best of our and belief as surveyed and platted under -our
direction'in April, 1988. We further certify that this survey complies
with the Minimum Technical Standards for Land Surveying in the State of
Florida, Chapter 472, of Florida Statutes.
A. R. TOUSSAINT & ASSOCInTES INC.
LAND SURVEYORS
620 N.E. 126 Street, North Miami, Florida
By:
Pres.
HOWARD C. GAMBLE
Registered Land Surveyor No. 1683
State of Florida
ORDER NO. 9208 F.A. 319, P. 65,66
Revised this 13th day of September, 1988 to show foundation location and
existing floor elevations.
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