70 NE 92 St (7)Remarks
peared
Disa
( Signed
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned au ority, a notary public, duly a
and who, being by me first
of the above described cons
therein by him stated are
Permit No.
d
Build r g Inspector
Chairman
Member
Member
Council Approved
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re- inspection fee of $1.00 will be charged
materials and /or workmanship.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTI IENT
APPLICATION FOR BUILDIN[ i PERMIT
Application is hereby made for the approval of the detailed statement of the plans an l specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and con ormity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordina tees of Miami Shore Village and all rules and
regulations of the Building Division of Miami Shores Village shal_; _– omplied with, whe her herein specifier not. A copy of approved
plans and specifications must be kept at building during progre of the k.
Owner's Name and Address A 01
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
�,���— and for no other purpose.
New Building Remodeling Addition .C' Rep irs No. of Stories
To be constructed of Kind of foundati
Estimated Total cost of improvements $ �v Amount of Permit
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lo
Maximum live load to be borne by each floor
- , , All notices wi
I hereby submit all the pl n c n 5. o n n n.
..r sent �, _ � � _ 2 � �,
—. - e e sined ;f r : ?s �`+.er t •: _ ! ,/ e th un�'e
of labor un. r the Florida Wo , en's Compensation Act, being Section 5966, Compi
has co r . plied with the pr c� sions thereof, and will require similar compliance from al
in the w' % to be performed under this permit; and will post or cause to be posted for in
or notice "as are required by the Act. The undersigned agrees to employ only such subcp
permit, as are licensed by Miami Shores Village.
d * y orn, upon oath poses . nd say
n, that he has, th
(Signe
PLANNING BOARD
Member
Member
Member
Date Disapproved
or changes to this a
oriz d t administer )a`ths aryl
__DATE
d, Sworn to nd Subscribed before me.
o the uilding a rt/ onstru.ction may
nds and a •opts h ` . . ga ions as art emp Oyer
;eneral L. s of Florida, Permanent Supplement,
contractors or sub - contractors employed by him
)ection on the site of the work such public notice
ttr on work to b • erformed under this
ake ac now edgments, personally ap-
to me well known,
hat he is the
oregoi -': application, nd that he did sign the same, and that all facts
Notar) Public, State of Florida
My Commission Expires
Date
tplication after approval has been obtained from
when such re- inspection is made nece::ary by improper notice for inspection or faulty