420 NE 92 St (4)Registered Architect and/or Engineer ......
Name and address of licensed contractor. i ... 4
tvilAMviI SHORES VILLAGE
l.11.)ILDINCX I NSI'[t: T Ott :)LPAIZTMENT
APPLICATION! FOR BUILDING PERMIT
Application is hercny Londe for the approval of the detailed stat,.,,,,•ni ui use pians and specifications herewith submitted for the build
inc ur other r aructuiv herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores \'IILiFc, Florida. and all provisions of the Ldws ed the State of Flurid.*, all ordinances of Miami Shores Village and all rules and
regulations of the duilshng Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approval
plans and specifications must be kept at building during progress of the work.
/6/4,(i)t# 2 8v5/
Osvrtcr'� Name and Address . l 0�3 w
Location and legal description of lot to be built on:
Lot 7 Block.... . Subdivision _
St-eet and Number wher.: work is to be done `7 2t 1' 9. £" / /OA /O _ 6 J' 2 /�1 y /
State work to be done and purpose of building (by f loyrs)...�f..�.r9i�l1. -- �. __ s�..._ 5,/,746
iv/h&c/L/6
os
1" 9y ir 97/
ede ma
Date �. _.__ y S � p _ _..._. er
No 1 Strect.lL .G,l.1 1 1•�N
.,,,. N ................ .sees..., / ,.
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 $ s r �*y �' �� A of Permit &.
Zone cubage required .flan Cubage
Distance .to next nearest building. Size of Building Lot
Maximum live load to be borne by each floor
1 hereby submit all the plans and specifications fur said building. All notices with reference to the building and its construction may
be sent to..
The un tersigocd applicsnt fur this building permit does hereby certify that he understands and accepts his obligations as an employer
of Libor under the Florida \ \'oxknun's Compensation Act, being Section 5)(iG, Compiled General Laws of Florida, Permanent Supp!core
and has complied ssith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hips
in t1;e work to be performed under this permit; and will post or cause to be posted for inspection on e site of the work such public notice
or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors d work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLOJ IDA,
COUNTY OF DADE. ss.
Before roc, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
ai,d who, being by :,,c first duly sworn, upon oath deposes and says that he is the.
of tl:e above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
thetcin by him suited are true. /
Pe rmi No. ._.. 8� �'1 Date �7/I e Head, Sworn to and Subscribed before me.
Disapproved ilia - 't� ... Date.._......
( Signed)
Notary Public. State of Florida
Building inspector My Commiuion Expires
PLANNINC BOARD ............ _.._......DATE
,5 ?9/
Member
to me well known,
Chairman
n
\:cn.bcr ........ Memhcr
!.t.•rnl,r:r _ ... ..... ...... Mernber _.._....
Cuunci! h,;.tli�ved Date Disapproved ...Date
t , : i . • n c 1,.,i ge of 1.00 will be made fur making corrections or charges to this application after approval has her-n n':.: ned (nom'.
the 1': .11i,11. ; L'u.,rri
A r,•••i, , ti.,;. i. e c.f a: Go will be charged when such re- inspection ix made necessary by improper notice for inspection or fruity
W.u.r,als Pled/ Ca w