715 NE 92 St (13)Permit No
Disapproved ___ _____________ _ ___ _ __ __ _ ___ Date_.__ . .
(Signed) 16/ _ 1
Building Spector
Chairman
Member
Member
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 build-
ing or other structure herein described. This application is made in compliancy: 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.
Owner's Name and Address. -. v W_. _ _ / A -�/
Registered Architect and /or Engineer.. _ // �- /
Name and address of licensed contractor_.(t a?�
Location and legal description of lot to be built on:
Lo. ____ ____________. _ .___ Block Subdivision.
Street and Number where work is to be done -3
State work to be done and purpose of building (by floors) Ze
New Building Remodeling Addition__. - .__ Repairs__
To be constructed of Kind of foundation
Date
PLANNING BOARD
Date
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.
Date_ _ -
No.._ Street_
and for no other purpose.
No. of Stories
Roof Covering
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required _Plan Cubage__
Distance to next nearest building Size of Building Lot
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)_ '
STATE OF FLORIDA,
COUNTY OF DADE. Ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
DATE
Member
Member .
Member
Disapproved
Date
or changes :o this application after approval has been obtained from
when such re- inspection is made necessary by improper nonce for inspection or faulty