801 NE 92 St•
•
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and s cifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and confo ity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinanc s of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, wheth r herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
•
1 -..
Owner's Name and Address___ __ L ' _ _ - ;______�__,_.:__ -r No Street
Registered Architect and /or Engineer_ ___ _ _-__
1
Name and address of licensed contractor_ '�1'_L Y' ._�`.0� +� '_l (Wit ") f' 1 _t _1
Location and legal description of lot to be built on:
Lot v' I3 Block r Subdivision � 1c� Iti '% t '? � '
Street and Number where work is to be done. ? '- I •1 �
State work to be done and purpose of building (by floors )____�- _�__ Y i��; }) ? ___- __���'
- -- and for no other purpose.
New Building / Remodeling Addition___ Repairs No. of Stories
,
To be constructed of__1C, ,�./.2 ____ Kind of foundation____ lilt Cat le..,_ Roo�C�pvering_ ti_"_e / / /ll�
.11 �7 z
Estimated Total cost of improvements $_ 0 0 6 __Amount of Permit $__ _
Zone cubage required ___._._ ti _a76__:._ _ ______ _Plan Cubage_ _ !S._r__ _--
Distance to next nearest building. '_,-02, _:- ____. Size of Building Lot '..2 _ ___ ___%_ Ci _C)
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 -- % ' . r _+....,-_'_ r' -f. `._ 44.4 -r j 1 . I. ..,..(1_,._ J 4 -4. - - -1 I S • / f 9 r - - mot
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations a'‘n 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
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
Before me, the undersigned authority, a notary public, duly authorized t administer oaths and take acknowledgments, personally ap-
peared
and who, being by e first ly worn, upon oath d poses and says th he is the
of the above descr a cons uqt, that he has care ly re the for oing application, and that he did sign the same, and that all facts
therein by him sta are / ��
Permit No - Date Read, Sworn to and Subscribed before me.
Disapproved
( Signed)
uilding fnspecto
•
- MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Date - , 19
(Signed)
PLANNING BOARD 1 DATE
76-
i3 -.
to me well known,
Notary Public, State of Florida
My Commission Expires
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 $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
• "61' s 1"
0
IS'1"
2,5 ' 6 '1 4S SLof
25'C
t "
GA: O'
- Tort_ pe,aGA' GA % 31421
•i(c.L.1.)1>et> (
01) 5110•4z2.11"-=-- — 1034.1
1 cLi..0
234 A 121
2 2." = 4
48 x 55' I= g L3
‘ac za I 5,3
Ca
AT I o
f% ,5f) Le• s -
c ule-L 0,co
37W.,:.--: 1 3
1
11,
Tt
-
Lo L2. F4, — BLocitc,
LO.) Gi Alat. I\C‘AK)
801 12.. Sa2
i
3413
--- G
3 --
=-)
epT
—411■Kar,„:..arsmaT=