890 NE 92 St (3)4
MIAs I SHORES VILLAGE
BUILDBNG BNSPECTBON DEPARTMENT
PPLBCATB®N FOR `= BUILDING PE - MIT
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 rdinance 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 ° Harlan - 89 D NO ' o .9 Sts: N _Skti s Str —
Orkin t. Co ° ® 1960 GW o W. 27 4kyp .Est
Registered Architect and /or EngineeP i!!!•••.TTT••!tf. ^. 15i,
T.4R. .T!
Name and address of licensed contractor ..
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to done 890 LE. 92 Sts i_anra —. —.
State work to be done and purpose of building (by floors) Nylon Tent Ftmian
$306 •00 `.//�� e
and for ao other purge;.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ Amount of Permit $.
Zone cubage required _Plan Cubage
Distance to next nearest building Size of Building Lot
Mfaximum 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 pennit 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) ZL
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
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 =Me, and that all facts
therein by him stated ar true, Z _
Permit No..____ S Date ' Read, Sworn to and Subscribed before me.
Disapproved
(Signed)
Building Inspe. or
Notary Public, State of Florida
to me well known,
My Commission Expires
ANNING BOAR ;r DATE
Chairman Member
Memmber 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 af¢er approval has hecn obtained fro
the Planning Board.
A re- inspection fee of 51.00 will be charged when ouch re- taapection is ma () aeoeszary by impala ratio feat frzaa¢iara of faulty
materials and /or workmanship.