890 NE 92 St (5)MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of we plans and specifications herewith submitted for the build
in 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 *I) rules and
regulations of the ilttilding 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 cl - / q
Owners Name and Address L 1-1 ^ t ..� ' r' No._ ....... Street—t!1 �� a
Regi stered Architect and /or Engineer ......... ........_.._..._...._....._..._ ._ _._.........._......_....••.,, t,........•-.. „•,.....,.,,....•M....,M,. -...
Name and address of licensed contractor
/ a el �"t' 9 ` S s” 5 A "/ i 4, ` t"'' `; 4 It `�
Location and legal description of lot to be built on:
Lot_ _ Block. _ ...._._ Subdivision
Street and Number where work is to be done. .._.. _ _... /V g q `g '
State work to be done and purpose of budding (by floors)
H ° e G- / - / I '7 :._ .__`' 'i
!„t 11 r 4 .._ .C..:. _.. _. __
_sod for no other purpose.
New Building Remodeling Addition Repairs No. of Stories ............— _
To be constructed of Kind of foundation....._.._._. Roof Covering 141 Estimated Total cost of improvements 3.......... 1...__ »...___ »..._ /\mount of Permit >f...
Zone cubage required _.__._.__ Plan Cubage
Distance .to next nearest budding
Maximum live load to be borne by cash 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 i imlersigned applic:,nt for this building permit does hereby certify that he understands and accepts his obligation% a% an employer
of Libor under the Honda Workmen's Conspcnsatiot, 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 tinder 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 tinder this
pcnnit, as are licensed by Miami Shores Village. „
Rem.uks —.. ._.»._ (Signed ) _3�.:_c' ' -
STATE OF FLOI:IDA,
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. _ „_
ts
of tl.e above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all fac
therein by him stated ars. true. Permit No ....24..._._.. Read, Sworn to and Subscribed before me.
Disapproved _..._.. Date Notary Public, State of Florida
(Signed) A.. .V
Building Inspector My Commission Expires
PLANNING BOARD _ .._._._...DATE
Member.._.__.........,
Memb _ _._..._
— ....._......_..-- •— ••- ._..... _ 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 hero obtained from
the Plannit.g Board.
A rc•inspection fee of SI.00 will be charged when such re- inspection is tirade necessary by improper notice for inspection or faulty
materials anti /or workmanship.
Chairman
4fcrr,bcr
Member
Size of Building Lot
to me well known,
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BUILDING & IUNING - AUMINISTRATION
PLOY PLAN
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