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818 NE 92 St (3)MIAMI SHORES VILLAGE BUILDIN INSPECTION DEPARTMEN APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the deviled statemen. of the plans and specifica ions herewith submitted for the build- ing or o h, 7ructure her i described This i-t licatic is made in compliance and con o'm ty w.th the Building Ordinance of Mia u Shores Villatie, or da, and all pro isions of the Laws c f the Statu of 1 krid. all o d nances ,,f Mi ni Shores Village and all rules and regu a ion, of the Building Div . i of lam Sho. iilage 1' '1 e , o ipl.ed with, whether herein specified or not. A copy of approved plans and specificati n must be kci -• at building durin progress of tl.e wcrk. Date , 19__. Owner' Name and Address._. /'? 14 46924 C 0 i\f No Street Registered Architect and /or Engineer._ Name nd address of licensed contractor d'dN Location and legal description of lot to be built on: y Lot __ _ -._d _ r � r��'.. Block . __ Subdivision @dam' 1 ' , /Y j 4 Street and Number where work is to be done_ __ - - J..__ �- - "'�� <3, d>V ent? 7' ©/ie'a State work to be done and purpose of building (by floors) - 4 ; 7 New Building _ _ Remodeling __ _ Addition__ -_ ____ . __ _ Repairs. _ No. of Stories To be constructed of e s _ Kill /-of foundation e ® Ai Roof - Cov sing__ Estimated " :tal cost of improvements $ _. Amount of Permit - $._ . , � 9 – Zone ^ubage required __. _-Plan Cubage_74X__._f 1_(/E lam ' �.Sj 760 00 Distance to next nearest building__ _ _ Maximum live load to be borne by each floor _ _ _____ ___ ___ hereby submit all the plans and speciii,^ations for said building. All notices with reference to the building and its construction may be sent to The unde signed appli ant for th 's building permit does hereby certify t'iat he understands and accepts his .•bligations as an employer of 1 bor under he Florida Workmen's Compensation Act being S. -tion 5966 Col p led Gen al Laws of Florida P r anon S tpplc Went, and h s compl ed w'th he prov' :ions thereof, and will require s.milar coma lance from all contractors or sub - contractors cmplo .ed by him in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of the work su ,h public note e or .otices as are requir d by the Act. The u. d, r ign -d agrees to employ only such ab ntr. ctors, work to be perform d der this permit as are licensed by M ani, Shores \ il': ge. Remarks__ _ .. (Signed) _ -- " O PLANNING BOARD Chairman . - _. _ Member Member ____ __ _ _ ______ .._ __ Member Member _ Member Council Approved ___. - _ . Date Disapproved and for no other purpose. _Size of Building Lot i ll 95 97 9 7 - 46",. STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths “nd take acknowledgments, personally p- peared - --- to me well known, and who, being by me first d ly , worn, upon oath depores and says that he is the of tli abov de .e ibed . istruction t . h has careially read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tr.ie Permit No < % , _ _ Date__ .Z/ ° C . / ; __ - _ ._( Read, Sworn to and Subscribed before me. c Disapproved ________ ____— Date__ ( Signed) � > �' - \_ ng Inspector My Com:nission Expires Notary Public State of Florida _DATE Date NOTE: A charge of $1.00 will be made for making corrections or Changes to this application ft' -r approval li is been obtained from the Planr mg Board A re-- inspection fee of $1.00 will be charged when such re- inspection is m, .e necessary by improper notice fc-r inspe.-t or fa ity inatenals and /or workmanship.