905 NE 92 St (13)State
New Building_
Disapproved
(Signed)
Architect and /or Engineer
Name and address of licensed contractor_
Street and Number where work is to be done
MIAMI SHORES VILLAGE
ork to be done and p ose of building (by / flloors )
6., 4 �r 0 4 cad & o to aQQ_!� ct (DC
- "f
Estimated Total cost of improvements $
BUILDING INSPECTION DL IP•' L FiT MENT
PPLICATION FOR l UOIL WLM 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___ s�3 r U �'� n °
Location and legal description of lot to be built on: 62 �" De_
Lot_ __bt Block Subdivision__ Go e- -- 6 e27
Remodeling Addition
To be constructed of__.( _ Kind of foundation Roof Covering
Amount of Permit 6
Zone cubage required__ - - -- __—flan Cubage_ a i
Distance to next nearest building ___ —Size of Building Lot
Maximum live load to be borne by each floor
I hereby submit all the plans end specifications for said building. All notices with reference to the building and its construction may
be sent to �/ --- ie __z'%l
- -- ------ ------- - - - - -- - -
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 5988, 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)
Date
No .. Street
and for no other purpose.
Repairs
1, is
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
,19 C
o ,o
0,V ^7 1/,/� r 5 7 G L
No. of Stories
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 __
- - - -- to me well known,
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 e true.
Permit No t stated Date _ Rr� 2
-
Building Inspector / J My Commission Expires
PLANNINCjd3OARD 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 1, rtu e for inspection or faulty
materials and /or workmanship.
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