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966 NE 92 St (3)a i MIAMI 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 building 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. 0,flLC- � O�j Date -� 2 3 19 C Owner's Name and Address 9 Cp G `� • t. 9 ' ` 2 , i' 4 / j � / f_65' No. Street_ Registered Architect and or Engineer Name and address of licensed contractor 0 t(./4/ Location and legal description of lot to be built on: // 3 11' 4 / e /' 7 Lot Block EAl Cr l0 i l -4 Subdivision /4 4 4 D PC-47 B LA C'/4 q K Street and Number where work is to be done (6 G k•6• 9 2 57 ' /4(4 / s fy-o P-65, / -oe-r-4A • State work to be done and purpose of building (by floors). state exterior colors (submit samples) C �° — S• ' 4 6 . T — 0 1 4 1 O F /I4/ 66h/206, t O N 6471 0 /t/C 6 6 200/4 New Building Remodeling Addition Repairs No. of Stories and for no other purpust. To be constructed of 0_ F.)‘5, Kind of foundation Roof Covering =POI A/l)r--C.77 Estimated Total cost of improvements S 9' / ( sv Amount of Permit $ � GJ Zone cubage required Plan Cubage f " `�' ° " 6 �✓'7 Distance to next nearest building 2_e Size of Building Lot (8 © 0 VA' 164 Z7 Maximum live load to be borne by each floor 1 hereby submit all 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 obligatons 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 ploy ly such subcontractors, erl work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA COUNTY OF DADE. Before me. the undersigned authority. a notary public. duly authorized to administer oaths and take acknowledgments, personally appeared 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 fore going application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. 1 NY' Disapproved (Signed) ss Date .5 23 6 Read. Sworn to and Subscribed before me. Date Notary Public, State of Florida Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved to me well known. Date Disapproved Date NOTE: A charge of 525.00 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 525.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and or workmanship.