80 NE 92 St (13)Owner's Name and Address
Disapproved q Da
(Signed) -
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 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.
Registered Architect and /or Engineer
Name and address of licensed contractor__„
Location and legal description of lot to be built o : .7))
Lot ' )(77 !, 4 6 TBlock f Subdivision.. -
Street and Number where work is to be done 8 D Y 9
State work to be done and purpose of building (by floors)
and for no other purpose.
New Building _Remodeling Addition, , Repairs No. Ses
Kind of � Roof Covering. jam!! //
Estimated Total cost of impr6vements $_, �. J _ 9_.Q.1.q .!._ Amount of Perm /� ,
Zone cubage required Plan Cubage v l� �% . ' / i •• ' '
Distance to next nearest building. Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building pennit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on ke performed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed
STATE OF FLORIDA, t
COUNTY OF DADE. J ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the.
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true. _
Permit No �J Y Date f' ` Z r Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
3oNO 2z$o
/ E-2ns / / j `f o
L� c:=,u S&- 7-o•74
Building I spector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 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 51.00 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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SKETCH OF SURVEY
Lot 3 and the West 12 feet of Lot 2 Block 1
AMENDED PLAT OF MIAMI SHORE5 according to tho
Plat thereof recorded in Plat Book 10 at Page
70 of the Public iecords of Dade County Florida
0 Order No0 20426 April 12 1956
FOB0rr 4303.8 Scales shown
I HEREBY CERTIFYa That the attached "SKETCH OF
SURVEY" of the above described property is true
and correct to the best of my knowledge and be-
lief as recently surveyed and platted under my
direction0
HARRY C. SC1WEBKE & ASSOCIATES INC.
Robert C Schwebke
Registered Land Surveyor #1067
State of Florida
Vice Pres.