905 NE 92 St (2)STATE OF FLORIDA, I
COUNTY OF DADE. ss.
Chairman
Member
Member
Council Approved
MBAM SHORES VILLAGE
U LDONG ONSPECTION DEPARTMENT
APPLOCATBi #FI FOR BUILDING PERMIT
Application is hereby snade for the approval of the detailed statement of the plans arid 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.
Date 1-29-
,19 7 C
Owner's Name and Address
S. Benedict No 905 Street N. E. 92 S t.
Registered Architect and /or Engineer
Name and address of licensed contractor -__) de G - Corcrgany, 955 ? 5 St, H is 1 een,
Location and legal description of lot to be built on:
Lot._ Block Subdivision
Street and Number where work is to be done 905 N ° E ° 92 St.
State work to be done and purpose of building (by floors) D ?4°>_K° set to present gas f.aL °' a l :'.at „ -On
and for no other purpose.
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__
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, Pennanent 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 su.contractors, on wor to be performed under this
permit, as are licensed by Miami Shores Village. ,r 1
l &
Remarks -- --- -- - -- - - - -- -- - - -- - (Signed )- t� - ` 4 048440-C
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 are true.
Permit No._____(_1 __ e if Date 3.- Read, Sworn to and Subscribed before me.
Disapproved ._
(Signed)
Building Inspector My Commission Expires__
Notary Public, State of Florida
PL �+' ING BOARD__ __ . 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 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 inspt, ;ion or faulty
materials and /or workmanship.