546 NE 92 St (2)MIAMI SHORES VILLAGE
STATE OF FLORIDA
COUNTY OF DADE.
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BUILDING INSPECTION DEPARTMENT
LICATION FOR BUILDING PERMIT
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Subdivision
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I of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein
ice and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the
s Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether
ins and specifications must be kept at building during progress of the work.
Plan Cubage
Remarks (Signed
No.
Date 2 —
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g Iby floors), sta ex rr colors (submit samples) C^!' d p,A4--ate-5 ✓Ld
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and for no other purpose.
g Addition Repairs '� No. of Stories
u Kind of foun tion Roof Covering
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00 r1;, 10�f 5 Amount of Permit S a.J „ Q
Size of Building Lot
is for said building. All notices with reference to the building and its construction may be sent to 4 WO
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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 emplo • . .. . . o' tractors, on work to be performed
under this permit, as are licensed by Miami Shores Village.
Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments. personally appeared
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.
Date oG
Read, Sworn to and Subscribed before me.
to me well known.
Permit No.
Disapproved
(Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved
Date
Notary Public. State of Florida
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 825.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship.