815 NE 92 St (2)Location and legal description of lot to be built on:
Lot / %t2 _fd Block
Street and Number where work is to be done
State work to be done and purpose of building (by floors
Kind of fou
Estimated Total cost of i p ve nts
Zone cubage required_= _
Distance to next nearest bui /ing
Building Inspector
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 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 ._ ..._ _
Registered Architect and /or Engineer �,
Name and address of licensed contractor (. _ ,� �,7 f- f i „ _
ubdivision - - -.
‘11.1
Disapproved Date
(Signed)
and for no other purpose.
New Building L' Remodeling Addition Repairs No. of Stories
To be constructed of ____
on I � _ . .__ C�hZ2e
Amount of Permit $
_Plan Cubage
of Building Lot
_ -
No Street
_w•
ering
19.t.1� 5
Maximum live load to be borne by each floor
I hereby submi the plans an ecifica ions said building. All noti es with reference to the building and its construction may l a sent to .-a __ G.°7_z„,r ! r� ',,, , , ,/ /7- 2'4<pz
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 w.r. ch public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wo perfor ed un.= this
permit, 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
- -- - 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.
Permit Ne Date.,/e_ _ Read, Sworn to and Subscribed before me.
®� .. _
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
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.