325 NE 96 St (10)Disapproved
(Signed)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed stateiuent ur vie 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 ill 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 specification; must be kept at building during progress of the work.
-// Date... / �f •r•�- 7 .f, _�_....., --._. ,18...,._
Owner's Name and Address�T:tgOLD JAL.,6A,e , _ No 3 #.1�...... ,... S treet_. 96- ......_ . •
Registered Architect and /or Engineer . J �} , ,,,, ,,,,,,,, +. r,
Name and address of licensed contactor !J AA4ES '7. 4 fA..ER.S oN r b. S.._ _ _
Location and legal description of lot to be built on
Lot Block Subdivision
Street and Number where work is to be done Sot. ?(,.Sr
E' _
State work to be done and purpose of building (by floors) eize. • D °wAtY Q . t d0O - T
Zone cubage required...,
pate.._.. ......
_,
r•+
, _.._ and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation . ,,Roof Coyering
37
Estimated Total cost of improvements S I Amount of Permit S r ,
,...Plan Cubage r
Distance to next nearest building Size of Building Lot..,
Maximum live load to be borne by each floor
I hereby submit all the plaps and specifications for said building. All notices with reference to the building and its construction may
be sent to.. Col--11
The umlersipocd applicant for this building permit does hereby certify that he understa • . s and accepts his obligations as an employer
of i.thur under the Florida Workmen's Compensation Act, being Section 5966, Compiled •eneral Laws of Florida, Permanent Supplement,
anti has complied ssith the provisions thereof, and will require similar compliance from a 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 i spection op the site of the rk such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su • •ntractors, on wgrk performed under this
permit, as are licensed by Miami Shores Village.
Remarks __..,_.__ (Signed T .. !t! = y`�1.' � _—,. �a...e
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peragnally 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 saute, said that all facts
therein by him stated are true. J.9419. Permit No X�Ll.1 Date ...)... ............_._ Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
Building Inspector My Commission Expires..
to me sr ell known,
PLANNING BOARD DATE
Chairman Member
Mcu.ber ,. 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 liu.rrd.
A rc••iu.pection fee of SI.00 will be charged when such re- inspection is made necessary by improper notice for inspgytinn oe Jaulty
materials and /or workmanship.