806 NE 92 St (10)Disapproved Date
(Signed) l...
Building In 'cctor
MIAMI SHORES VILLAGE
Chairman
\Icrnbcr
Member ..... - - - ._ .....
Council Approved
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR
PLANNIN
Date
UILDINO 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 beecept at building du ingg progress of 1/X' th e wofk.
Owner's Name and Address .... °
Registered Architect and /or Engineer.. e1... MT • :+, e:erees+rme:•:rn : nes
Name and address of licensed contactor
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done o_ ivz ....
State work to be done and purpo* of building (by floors)
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation R f 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 understands and accepts his obligations as an employer
of labor under the Florida Vorkmen'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 wo to be per ed under this
permit, as are licensed by Miami Shores Village. ( /J "
Remarks (Signed) ` - �t /
BOARD DATE
Member
Member
Member
Date Disapproved
Read, Sworn to and Subscribed before me
Notary Public, State of Florida
iv1y2ommission Expires
or changes to this application after approval
NOTE: A charge of $1.00 will be made for making corrections
the Planning Board.
A re- in.pection fee of $1.00 will bc charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
STATE OF FLORIDA,
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.
�r , ci f °1
Permit No.. - - - -.
Date
has been obtained from
for inspection or faulty
- _
/
ij
\■_
STATE OF FLORIDA,
COUNTY OF DADE. j ss'
ar
L t &'jam de,„
MIAMI SHORES t� o �
VI LLAG E
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade 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.
Owner's Name and Address .... !� �fC '. % „ (+� .... No. .L®` -� . Street / A t/
Registered Architect and /or Engineer A eF,, � �/? ,�' ,,••,.,(,
Name and address of licensed contractor . 22 ,,._.,.,�� 1 �d.y ,,,.._ „___,.,, ...,,_• -,� .,
Location and legal description of lot to be built on:
Lot -. - -� •',�. - -. f..� Block P- Subdivision...... a,./.42.e.A/ .. �� Pc . )zzi ” 7.7 AO . —
Street and Number where work is to be done !Sr. ti/ , C
State work to be done and purpose of building (by floors).
and for no other purpose.
New Building Remodeling Addition Re airs No. of Stories
To be constructed of ...... . ✓. p .S.t Kind of foundation.. 0..r N4? T.. /..0. 4J L ./i gt7 oof Covering 4.€
Estimated Total cost of improvements $ Amount of Permit $,.. Sa_ :
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot _ .. f p.(,_ /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 const tion may
be sent to
/^ate (& Air .S Rat"'
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, Pennanent 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 subco tr Etors, on work to be performed under this
pennit, as are licensed by Miami Shores Village.
Remarks _......_._..___ _ (Signed)
Before me, the undersigned authority, a notgy 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 tfu
Permit No. / CI Date " Read, Sworn to and Subscribed before me.
Disapproved ___.., _.__ � Date.
(Signed)_... ... �,.
nspector
•
PLA . INC BOARD DATE
Chainnan Membcr
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 13o:ird.
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.
Notary Public, State of Florida
My Commission Expires
3
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