849 NE 92 StMIAMI 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 I lorida, 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.
Date ., 19
Owner's Name and Address
Registered Architect and /or Engineer
Block:
C
t.
Name and address of licensed contractor -----------
________.
Lua and legal descriptpn of lot to-lie built on:
Lot:
Street and Number where work is to be done
z
State work to be done and purpose of building (by floors),
Subdivision
No
•
__ lam Street
and for no other purpose.
New Building_____ Remodeling Addition Repairs No. of Stories
To be constructed of /_____` __. Kind of foundation .1
/ (
Estimated Total cost of improvements ,, _ ______Amount of Permit $
Zone cubage required
Distance to next nearest building
Remarks__ (Signed)
STATE OF FLORIDA, I
COUNTY OF DADE. ss.
(Signed)
Chairman l
Member _ – ; -- - . __ - • -- -__.
Member
Council Approved Date
Roof Covering _________
_r> flan Cubage
�
I / —�' ____Size of Building Lot �/ % i
v
Maximum live load to be borne by each floor_______________ -__ ______/_1
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 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 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.
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 swo n upon oath deposes and says that he is the
of the above described construction, �i the 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 s ° L% Date Read, Sworn to and Subscribed before me.
Disapproved Date
� Notary Public, State of Florida
Building Inspector My Commission Expires
PLANNING BOAR))
= -DATE
Member
Member
Member
Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice
materials and /or workmanship.
Date
has been obtained from
for inspection or faulty
V
Street and Number where work is to be done__ r _''
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
ij
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 cons ormity 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.
Date
Owner's Name and Address_I1.1.2,4_ __ . _ f _ No Street
Registered Architect and /or Engineer - a %17;
Name and address of licensed contractor 2"/ -
Location and legal description of lot to be built on:
Lot__ i Block. Subdivision , _er; er7 4
State work to be done and purpose of building (by floors)__
— s and for no other purpose.
New Building Remodeling Addition Repairs No. of Storics
To be constructed of �_� -_� Kind of foundation Roof Covering // 72"
Estimated Total cost of improvements $___ 'A Amount of Permit $:._
Zone Cuba e required g q -------------------------- - -------- - - - - - - -flan Cubage <j=
Distance to next nearest building Size of Building Lot U
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 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, 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 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. ss. r -
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well
and who, being by me first duly sworn, upon/oat .1 deposes and says that he is the e _ _ _
of the above described construction, that he, _ application,
therein by him stated are,'true.
Permit No. . -__ 1._.. Date
Disapproved Date
Notary Public, State of Florida
(Signed) _, _. 1.
Building Inspector jj My Commission Expires
J 9,
PLANNING BOARI,� 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.
Read, Sworn to and Subscribed before me.
, 19 -
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