485 NE 92 St (7)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
PERMIT
0
0
Owner of
Building
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
N? 2479
Work to be performed under this Permit
•
B1
Subdi-
vision
Value of
Project
S
DATI! -
195'
Contractor's
License No.
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. ✓" ^ 1" °
f r
Signed. BY " j t ._ r'f,
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining th to and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In as
cepting this gr I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit No...,
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date -
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 work. j
Owner's Name and Address 41
.. _ .... ---- -.... ___ Street_
Registered Architect and/or Enginear_
Employing Plumber's Name / ' ''
Location and Legal Description Lot Block
Street and Number where work is to be performed—No -a .--
State work to, be performed and purpose of building (By Floars)____ _
ew Buildini_______ ......... . _______ Remodeling ___ Addition Repairs No of Stories
Size Septic Tank_ __ ___
Feet of Drain Tile_
Nature of Water Supply:{ Cit -Well.
Amount of Permit $ ___ -�
STATE OF FLORIDA,
COUNTY OF DADE.
Type of Tank
l'c No.
Street__—
b4tvision
Street
Capacity Gals.
_Dist. Feet of Tank or Drain Field from Well.
Size of Soakage Pit
( Signed )
Plumbing Inspector.
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 Permanent Supplement, and has com-
plied 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 sub- contractors, on work to be performed under this permit, as are
licensed Miami .r s
:; „(
Signed) - - -- t--:
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires Notary Public, State of Florida
NOTE: Ajlinspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and workmanship.
CLOSETS
BATH
TUBS
SHOWER•
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
�
-✓
TOTAL
FI %TURl6
CONTR.
LIST
L.IST
CHECK
- "' '.+
.
do:v °f
�V
..d
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM•G
POOL
r
J',
`
CL TR.
LI ST
r
- __
CHECK
Permit No...,
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date -
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 work. j
Owner's Name and Address 41
.. _ .... ---- -.... ___ Street_
Registered Architect and/or Enginear_
Employing Plumber's Name / ' ''
Location and Legal Description Lot Block
Street and Number where work is to be performed—No -a .--
State work to, be performed and purpose of building (By Floars)____ _
ew Buildini_______ ......... . _______ Remodeling ___ Addition Repairs No of Stories
Size Septic Tank_ __ ___
Feet of Drain Tile_
Nature of Water Supply:{ Cit -Well.
Amount of Permit $ ___ -�
STATE OF FLORIDA,
COUNTY OF DADE.
Type of Tank
l'c No.
Street__—
b4tvision
Street
Capacity Gals.
_Dist. Feet of Tank or Drain Field from Well.
Size of Soakage Pit
( Signed )
Plumbing Inspector.
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 Permanent Supplement, and has com-
plied 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 sub- contractors, on work to be performed under this permit, as are
licensed Miami .r s
:; „(
Signed) - - -- t--:
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires Notary Public, State of Florida
NOTE: Ajlinspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and workmanship.
_
Permit No
Owner's Name and Address
Registered Architect and /or
Employing Plumber's Name
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Lot_.__._ _________ ____ __._. — Block
State work to be performed and purpose of building (By Floors)_
New Building __ Remodeling__ _ ___ -__ Addition
Side Septic Tank
Amount of Permit $
STATE OF FLORIDA, I
as.
COUNTY OF DADE.
No.
Type of Tank__
(Signed j_
74
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 v�eck.
Street
Street_..------- ....... - ..... - -- --.......
_...__
f�+ -- —.. -- - Subdivision
Street and Number where work is to be performed —No. '' p _ � treet
Repairs No. of Stories
Capacity Gals
Feet of Drain Tile__ -- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .____ ____________________ ______ Size of Soakage, Pit
Plumbing Inspector.
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 Permanent Supplement, and has com-
plied 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 sub- contractors, on wprk to be per .rme. - e this permit, jp are
licensed by Miami Shores Village. 010°
arftwormsedIPO
(Signed) - -- r 4 4 r+
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: Are- 'on fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and/or yvctr p.
CLOSETS
BATH
TUB
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
I
SEPTIC
TANK
SEWER
CONN.
DRAIN
Pi MCI
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
CHECK
- --
s
Permit No
Owner's Name and Address
Registered Architect and /or
Employing Plumber's Name
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Lot_.__._ _________ ____ __._. — Block
State work to be performed and purpose of building (By Floors)_
New Building __ Remodeling__ _ ___ -__ Addition
Side Septic Tank
Amount of Permit $
STATE OF FLORIDA, I
as.
COUNTY OF DADE.
No.
Type of Tank__
(Signed j_
74
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 v�eck.
Street
Street_..------- ....... - ..... - -- --.......
_...__
f�+ -- —.. -- - Subdivision
Street and Number where work is to be performed —No. '' p _ � treet
Repairs No. of Stories
Capacity Gals
Feet of Drain Tile__ -- -Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well .____ ____________________ ______ Size of Soakage, Pit
Plumbing Inspector.
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 Permanent Supplement, and has com-
plied 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 sub- contractors, on wprk to be per .rme. - e this permit, jp are
licensed by Miami Shores Village. 010°
arftwormsedIPO
(Signed) - -- r 4 4 r+
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: Are- 'on fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and/or yvctr p.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
,�' �"�-
Permit = -__ Date_ --°
Permit No
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 work.
Owner's Name and Address_ -_ .•___ !e -- z- -, 'ti' C - •,--.'
Registered Architect and/ Engineer____— __,____—__ ___-__._�-�-- -�---___ -_-
Employing Plumber's _ s Name__ Larz _ �.1_a -_!.1_ L4 k_,U ? _ SIC: i N o. ' !_ — 6
Street_ _ 2- / e:
No. ` d _ S t r e e t _ _ L r
/ t;
Location and Legal Description Lot______ _______ Block__
Street and Number where work is to be performed— No.__-__ k
State work to be performed and purpose of building (By Floors)________ _____ ___ ... New Building___ -- -- __- ._---- --- - -- - - - -___ Remodeling-______ Addition_-- _ -_ -_._ Repairs No. of Stories.
Size Septic Tank ___---- _ -__ -- Type of Tank
Feet of Drain Tile_________ _ _Dist. Feet of Tank or Drain Field from Well
Nature of . — Well._ - S � %CiI S E�� _ 6`-p. :' l 6- 4,
Amount of Permit $_
Plumbing Inspector.
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 Permanent Supplement, and his com-
plied 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 sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires
(Signed)_
(Signed
Subdivision
Street it/ `
Capacity Gals
Notary Public, State of Florida
NOTE• A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
material and/or workmanship.
T'
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Toss
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
—
SEPTIC
TANK
SEWER
CONK.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTE
SWIM•G
POOL
COHTR.
LIST
- -- —
CHECK
-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
,�' �"�-
Permit = -__ Date_ --°
Permit No
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 work.
Owner's Name and Address_ -_ .•___ !e -- z- -, 'ti' C - •,--.'
Registered Architect and/ Engineer____— __,____—__ ___-__._�-�-- -�---___ -_-
Employing Plumber's _ s Name__ Larz _ �.1_a -_!.1_ L4 k_,U ? _ SIC: i N o. ' !_ — 6
Street_ _ 2- / e:
No. ` d _ S t r e e t _ _ L r
/ t;
Location and Legal Description Lot______ _______ Block__
Street and Number where work is to be performed— No.__-__ k
State work to be performed and purpose of building (By Floors)________ _____ ___ ... New Building___ -- -- __- ._---- --- - -- - - - -___ Remodeling-______ Addition_-- _ -_ -_._ Repairs No. of Stories.
Size Septic Tank ___---- _ -__ -- Type of Tank
Feet of Drain Tile_________ _ _Dist. Feet of Tank or Drain Field from Well
Nature of . — Well._ - S � %CiI S E�� _ 6`-p. :' l 6- 4,
Amount of Permit $_
Plumbing Inspector.
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 Permanent Supplement, and his com-
plied 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 sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
My Commission Expires
(Signed)_
(Signed
Subdivision
Street it/ `
Capacity Gals
Notary Public, State of Florida
NOTE• A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
material and/or workmanship.
T'
Permit No._._____ -- Date 3- _.
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 w . ` .
Owners Name and Address .0P ', ' -°__- - - . No. Street
Registered Architect and /or gineer-_-_-..---
Employing Plumber's Name _fie
STATE OF FLORIDA, 1
COUNTY OF DADE.
Street and Number where work is to be performed —No
as.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Amount of Permit $
( Signed) -
_ ..__ Street .._------- -- --- --- --- -- ---- - --
Location and Legal Description Lot. ` Blorti Subdivision_ _.---_----......
_-------___-
`� 9 Street.
State work to be performed and purpose of building (By Floors)_____ _---- _______ -___ _ - - -�
New Building______ _--- _.__- ....____ Remodeling _ Addition_.__- _._..____.... Repairs No. of Stories. . . ..............
Size Septic Tank__- ____ - -___- Type of Tank__ Capacity Gals.
Feet of Drain Tile- ft. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well.- ________._....____._.-.__.._____ ____ --Size of Soakage Pit
My Commission Expires Notary Public, State of Florida
binginspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S .element, and has com-
plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed __---_— , / .—_4 .2
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
TUBS
TUBS
SHOWERD
LAVA.
TORIES
SINKS
INK
SLOP
SINKS
LAUNDRY
Tune
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No._._____ -- Date 3- _.
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 w . ` .
Owners Name and Address .0P ', ' -°__- - - . No. Street
Registered Architect and /or gineer-_-_-..---
Employing Plumber's Name _fie
STATE OF FLORIDA, 1
COUNTY OF DADE.
Street and Number where work is to be performed —No
as.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Amount of Permit $
( Signed) -
_ ..__ Street .._------- -- --- --- --- -- ---- - --
Location and Legal Description Lot. ` Blorti Subdivision_ _.---_----......
_-------___-
`� 9 Street.
State work to be performed and purpose of building (By Floors)_____ _---- _______ -___ _ - - -�
New Building______ _--- _.__- ....____ Remodeling _ Addition_.__- _._..____.... Repairs No. of Stories. . . ..............
Size Septic Tank__- ____ - -___- Type of Tank__ Capacity Gals.
Feet of Drain Tile- ft. Feet of Tank or Drain Field from Well
Nature of Water Supply: City— Well.- ________._....____._.-.__.._____ ____ --Size of Soakage Pit
My Commission Expires Notary Public, State of Florida
binginspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligation an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent S .element, and has com-
plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
( Signed __---_— , / .—_4 .2
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.