812 NE 92 St (2)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approyal of the detailed statement of roe 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 thc. Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the 13uilding 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.
_Z. Z 19&
Owner's Name and Address ..0 "�1. � � .t_` .. — No. ' greet... 2...
Registered Architect and /or Engineer ,,.•- • „.•,,,, „,,,,,,,,,,,,,
Name and address of licensed contractor $0,,a�!x1. / . .._
Location and legal description of lot to be built on: � ���, ,
Lot as Block GI , � J Subdivision �¢ r� � – �!._._...i/... afi d 11 /
Street and Number where. work is to be done _........_..._._.. __ — .._..__.... _._..r.
State work to be done and purpose of building (by floors) P?� :/o' •si ?? 2 .11/L1% S
,F•
_..__ and for no other purpose.
New Building Remodeling t Addition Repairs No. of Stories
To be constructed of
Estimate Total cost of improvements $ Amount of Permit $...
Zone cubage required Plan Cubage
Distance .to next nearest building.. Size of Building Lot
Permit No.._
Disapproved
(Signed)
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 dots 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,
anti has complied ssith 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 noticcs as arc required by the Act. The undersigned agrees to employ only such su• • . ors, on work to be perrf y . d under this
pcnnit, as are licensed by Miami Shores Village.
Remarks (Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss'
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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 e true.
Date
Building Inspector
Kind of foundation
Date ....P/
z
Chairman
\Icrr,bcr
Member ..
Council Approved Date
NOTE: A charge of $1.00 will be made for making corrections
the Pl.innir.g Board.
A rc•in.pection fee of $1.00 will be charged
materials and /or workmanship.
Covering
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
to me well known,
PLANNING BOARD DATE
Member
Member
Member _.._.....
Disapproved Date
or changes to this application rafter approval has been obtained frrmrt
when such re- inspection is made necessary by improper notice for inspection at faulty