801 NE 92 St (13)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 building
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 regula-
tions of the Building Division of Miami Shore age shall be complied with, whether herein Wecified or not. A cgpy of approved plans
and specifications must be kept at building d ng p gress of the work.
Q1
Owner's Name and Address `' —� No.______ _ _— Street______
Registered Architect and /or Engineer
Name and address of licensed contractor t
Location and legal description of lot to be built on:
"fi t sZ d d
__ Block_ _Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
New Building t _______ Remodeling_
To be constructed of_______________ Kind of foundation Roof Covering__
Estimated Total cost of improvements $ ______Amount of Permit $
Zone cubage required_ Plan Cubage
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 permit does hereby certify that he understan and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled eral 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 i s ection 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
Permit No._
w
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE.
and who, being by me first duly
of the above described constru
therein by him stated are true
r r ,
Chairman
Member
Member
Council Approved_- -- - -_ - --
Addition_
(Signed)
MIAMI SHORES VILLAGE
�r t
and for no other purpose.
Repairs No. of Stories
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
plication, and that he did sign the same, and that all facts
ead, Sworn to and Subscribed before me.
Buildi . g Inspector My Commission Expires_
PLANNING BOARD___ DATE
Notary Public, State of Florida
Member
Member
Member
Date Disapproved
to me well known.
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.
Date