801 NE 92 St (5)COMPLIMENTS OF
FOLSOM PRINTERY --- 48-9389
Operated by George the Printer-900 S. W. LeJeune Road
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Owner's Name and Address_ L..#,4=..i -t
Name and address of licensed contractor -/ w'
Street and Number where work is to be done
STATE OF FLORIDA, I
COUNTY OF DADE. ss.
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 Hiles 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.
1
Registered Architect and /or Engineer
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Location and legal description of lot to be built on:
Lot J `t 1 It Block -___ Subdivision r d ''
State work to be done and purpose of building (by floors)
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Date
No. F Street A - t-
- and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories -.. To be constructed of Kind of foundation Roo f vering
Estimated Total cost of improvements $ , T 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
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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� "w.. a� , d. Le ■ C P. J i ^ i t # c y � �i (? 4 ✓ ` 1 • a rt i r
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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.
f ' / Y .' ; i �f, s • • ' ., + 4 , (tc ,,. ! ■ Remarks (Signed) M r e",,. r.
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 oatl and says that he is the .
of the above describe construction, that he has
therein by him are rue._
Permit No f "
Disapproved
( Signed) 4 - = :
Building Irispectbr
Chairman
Member
Mem
Council Approved
Date_
Date
refully read the foregoing application, and that he did sign the same, and that all facts
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bead, Sworn to and Subscribed before me.
PLANNING $O&RD DATE
Member
Member
Notary Public, State of Florida
My Commission Expires
Member
.Date Disapproved --- - _._.Date
NOTE: A charge of $1.00 will be made for making t ° orrections 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.
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