825 NE 92 St (3)BUILDING INSPE TION 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 ecelti FQ.,_
Registered Architect and/or Engineer C . 1..) A.9--,-.2 Ce.._ b .
Name and address of licensed contractor je/ S . .j2g.e...-4---re A 5 L4'2LJ . .
Location Tdlegldescripli, of lot to be built on:
Lot4.:_' --$.4.11,c1....444Block. 1 Subdivision .6 CI 1 e--;-' 6 C4 '7 (" , k _ ... _ _ aka
Street and Number where work is to be done gl.E.......40.E. s Tre-e-a
State work to be done and purpose of building (by floors) C r-fLe. X-4.- IThTe--..i 14 .
-- . _and for no other purpose-
New Building Remodeling Addition )‹.. Repairs . No. of Stories f - _
„..
To be constructed of_CA5 .S. Kin foundation Roof Covering_
Estimated Total cost of improvements $ 4_ 6 _Amount of Permit $ .4_
Zone cubage required__
Distance to next nearest building
Maximum live load to be borne by each floor
112 r-71k1A. h
I hereby submit all the plans and speceitiorafrA 24 g and
be sent to__ 353 N. W.
STATE OF FLORIDA,
COUNTY OF DADE. j 83 '
Before me, the undersigned authority, a notary
peared
•v■.)
Chairman
Member
Member
Council Approved
Building Inspector
MIAMI SHO
_Plan Cubage
__Size of Building Lot
6S VILLAGE
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Date LI_
r s i?
its construction may
..AND ALE fl.. .35).„, • -2
The undersigned applicant for this building Hoes befeby 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,
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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to
permit, as are licensed by Miami Shores Village.
Remarks
PLANNI BOARD...L. ......
(Signed)i
ublic, dul authorized to administer oaths and take acknowledgments, personally ap-
t iabSci '
1 (...L L 7 •
to me well known,
and who being by me first duly sworn, upon oath deposes and says that he is the -(7... 1 --'A - LI ( c- 6 Nz . ... ...._. -.-
of the above described construction, that he has carefully read the foregoing application, and that he did sign the sam , 9.11 tha all facts
therein by him stated are true. -
Permit No 1 /( ---::,----
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___ (
o and Subscri
_.. . D te. ....,_ _ ...--_--/ - b‘fre
Disapproved __-_-/Z ato'--------/-----
(Signed) _
rmed under this
t act-v , t-
Notary Public, State of F1
My Commissio pes . , ... .
. _ _
........... DATE
Member
Member
Member
Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has bee obtained from
the Planning Board.
A re-inspection fee of 81.00 will be charged when such re-inspection is made necessary by improper notice for insp. cticm or faulty
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materials and/or workmanship.