818 NE 92 St (8)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby uindc for the approval of the detailed statement ut cue 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 Divisinn 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.
Disapproved
(Signed)
Date
Chairman
MIcrriber
Member .
Council Approved
PLANNING BOARD DATE
Amount of Permit
19
O.vncr's Name and Address - 'H ._. No.. 2......_.. Street-0: Q o ,
Registered Architect and /or Engineer
N ame and address of licensed contractor Di e Q ... a ...�. _ __._...._ .............
Location and legal d •scription of lot to be built on:
Lot /. IY . . Block A. &::2ht. ���G1�Gtse
Street and Number where work is to be done. ne- 32
State work to be done and purpose of building (by floors).._. t n O!'._.
1�.. ac.. Q*- . - -L-{ r „ .. °La 1.. 'S f
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimates Total cost of improvements $ 3 ® G
$..
Zone cubage required plan Cubage
Distance•to next nearest building. Size of Building Lot
\faxirnum 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 Honda Workmen's Compensation Act, being Section 5066, Compiled General Laws of Florida, Permanent Scip dement,
anti has complied ssith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hips
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.
Remarks..._ (Signed)
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 _..
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 No. Date f l6 1 Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires
NOTE: A charge of $1.00 will be made for making corr or changes to this application after approval
the Plannit.g Board.
A rc- in•pec•tion fce of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials anti /or workmanship.
CL L je)Ll (.iL,C.)
to me well known,
Member
Member
Member
ate Disapproved Date
has been obtained fmtn
for inspection or faulty