700 NE 93 St (6)'
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050N E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204
xDate Job Address I " /1/E 9 rd -S - 1 Tax Folio
Miuliri S7�orrs, �/ 3 7, 3 /3 g
Legal Description / / Historically Designated: Yes No
Owner /Lessee/Tenet a/4 S �.�s L s4 A1,4 „er Master Permit #
Owner's Address 7U0 /1'Eq.3 rJ.5 / /q'a4,; .ShjoreS F/3.3 / 32 Phone ( 5 7 58 29Z. 3
Contracting Co. /ti%% /g 8 c ,2'2Q/ G f i A /
Qualifier SS# Phone( ' 7' — 5
ooa 6.00Y36
State # Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
WORK DESCRIPTION:
Signature o owner and/or ,Conde 'reside
tary as to Owner and/or Condo resident
My Commission Expires
311
J
Address
r y
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING
m .
Square Ft. Estimated Cost (va ul 2 2
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be 'one in ompliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work scat
Date Notary as to Contractor or Owner Builder
My Commission Expires
FEES: PERMIT /01 RADON C.C.F ( , Q NOTARY
APPROVED:
Zoning Building Electrical
Mechanical Plumbing
TOTAL DUE( , ()
Structural Engineer
Miami Shores Village
10050 NE 2nd Avenue
Plumbing Permit
Phone: 305 - 795 -2204 Permit Number: PL2002 -96
Printed:4 /23/2002 Page 1 of 1
Applicant: GLADYS LORETO CRESPO
Owner: CRESPO GLADYS LORETO
JOB ADDRESS: 700 NE 93 ST
Contractor MIKE & SON IRRIGATION Contractor's Address: 2370 SW 17 ST
Local Phone: 305 - 968 -5975
Parcel # 1132060141480
Permit Status: Approved Permit Expiration: 10/19/2002 Construction Value:
Work: SPRINKLING SYSTEM
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
$2,200.00
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOT 6 & 7 BLK 63 LOT SIZE 100.000 X
P .,)t2it - /a 000
C ‘Ps
Total Fees:
Total Receipts: $0.00
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
nd 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 reg lations 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, sery is or employees.
Signed:
In consider 'ati•''•f the issu
with the plans, drawings, st.
myself, my agent, servants
•
Signe
(INSPECTOR) BY:
to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
is or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
lops.
851.1A200 04/25/02T on 121.80
(Contractor or Builder) BY:
Date 4 - 7- 9- 14 / Job Address 7 Do Nt 98 $/
Legal Description L0r 6 ,
Owner / Lessee / Tenant /}D /tIl4.19
Owner's Address
Contracting Co. PHIP P,5i/it
Qualifier
State if
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WD.'I
WORK DESCRIPTION ke i'1 i 7X X001 -! p P/e,/ib/AIt►_ Ck.
Square Ft. Estimated Cost(value) 41
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVI
be done incom
sut e the
e of owne
Si g
Date:
Nota`Fy as to Offer and /or Clio President
My Commission Expires:1 — 7
** * *
FEES: PERMIT
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
70o ile 2 J'%
h'e,//2 v ✓ /
Municipal i
and or Condo President
•7 Abu /2 9 .
LIZEiTH
MY COMMISSF
IRES: kr
/J c l 3
Tax Folio 1/ ' to J / Nfo
x ft c, 3 :4_09t2 -
Master Permit U 33
Phone
U/J1,Q // Address /22 //e / 3 J7
SS# Phone f ?
Competency if /?TYZ Ins.Co. /Z '6 A
• certify that all the foregoing information is accurate and that all work will
: is ce wi ,; all apt..:- able laws regulating construction and zoning. Furthermore, I
actor to do the work stated.
o Contractor or Owner-lBuilder
Contractor or ' or-Builder
ssion
TArpuw.tc; ZTATE OFF ORI.^.A AT LARGE
MY COMMISSION EXPIRES NOVEMBER 11, 1994
BONDED THRU AGENT'S NOTARY BROKERAG9
* * * * * **
TOTAL DUE ;3t
C.C.F. l•''• NOTARY
Fire Other
Building r , Electrical
Mechanical Plumbing
Zoning
Engineering
Permit No L O q 9
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date. - L f s
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 Name and Address <'_'e L7 k dry __11_4 ° ,�1 - -- No._� - - -- ---- .- _-- - - - - - Street
Registered Architect and /or Engineer i Q fJS 1" U1d1 r� _ _ — __ — �_._
Employing Plumber's Name 9 536_11 .___ __741 1 _ a � ; o. - - -- - - -. Street__ _____
Location and Legal Description Lot M t•� Lam_ sa._. . Blo4 r Subdivisi
Street and Number where work is to be performed —No 7 i d /i/ eet
State work to be performed and purpose of building (By Floors ) _w
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 Water Supply: City—Well. - ______Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
13 ,_7
( Signed )_.._____
Capacity Gals
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 by Miami Shores Village.
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: A re- inspection fee of $1.00 will be made when such re- inspection is made•nec's'ary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
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
,p /pq
/' Y4
CONTR.
LIST
CHECK
_
--1-__
Permit No L O q 9
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date. - L f s
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 Name and Address <'_'e L7 k dry __11_4 ° ,�1 - -- No._� - - -- ---- .- _-- - - - - - Street
Registered Architect and /or Engineer i Q fJS 1" U1d1 r� _ _ — __ — �_._
Employing Plumber's Name 9 536_11 .___ __741 1 _ a � ; o. - - -- - - -. Street__ _____
Location and Legal Description Lot M t•� Lam_ sa._. . Blo4 r Subdivisi
Street and Number where work is to be performed —No 7 i d /i/ eet
State work to be performed and purpose of building (By Floors ) _w
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 Water Supply: City—Well. - ______Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
13 ,_7
( Signed )_.._____
Capacity Gals
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 by Miami Shores Village.
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: A re- inspection fee of $1.00 will be made when such re- inspection is made•nec's'ary by improper notice for inspection, or faulty
materials and /or workmanship.
gl;
fS f
Permit No /el a
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 ��� Pi�2 N 7 V D /vc Street.— . /
Registered Architect and /or Engineer
Employing Plumber': Name � ( &f �� � a .5 . 7,.
Location and Legal Description Lot_ Block Subdivision
Street and Number where work is to be performed —No Street_. _..._.._._
State work to be performed and purpose of building (By Floors)
New Building Remodeling____ ___— __ Addition.
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank
Feet of Tank or Drain Field from Well
Size Septic Tsn l0 S U
Feet of Drain Tile �dv0
Nature of Water Supply: City— /
(Signed)_
(Signed)
0130`
Repairs No. of Stories . . . .... ... . ....
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanent Supplement, andjas 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 ces as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work be performed cinder mit, as are
licensed by Miami Shores Village.
Muter Plumber.
STATE OF FLORIDA, t se.
COUNTY OF DADE. I
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 [ongoing application, and that he did sign the same, and that all fads
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when war rtsisspection is made•nsomary by bnproper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUS•
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUa•
URINAL[
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHICK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR
S
SWIN'O
POOL
COHTR.
LIST
r --
CHECK
gl;
fS f
Permit No /el a
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 ��� Pi�2 N 7 V D /vc Street.— . /
Registered Architect and /or Engineer
Employing Plumber': Name � ( &f �� � a .5 . 7,.
Location and Legal Description Lot_ Block Subdivision
Street and Number where work is to be performed —No Street_. _..._.._._
State work to be performed and purpose of building (By Floors)
New Building Remodeling____ ___— __ Addition.
Amount of Permit $
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank
Feet of Tank or Drain Field from Well
Size Septic Tsn l0 S U
Feet of Drain Tile �dv0
Nature of Water Supply: City— /
(Signed)_
(Signed)
0130`
Repairs No. of Stories . . . .... ... . ....
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Pennanent Supplement, andjas 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 ces as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work be performed cinder mit, as are
licensed by Miami Shores Village.
Muter Plumber.
STATE OF FLORIDA, t se.
COUNTY OF DADE. I
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 [ongoing application, and that he did sign the same, and that all fads
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when war rtsisspection is made•nsomary by bnproper notice for inspection, or faulty
materials and /or workmanship.
,1 a
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 V\.\. _L2- fVL4r_l 1 C 1 \J _,__ No Street
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
r
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engineer g
Employing Plumber's Name v 1[
g "7 Block 1.� _ Subdivision
Location and Leal Description Lot , C
Street and Number where work is to be performed —No _ � ,_: ' 5treet.+�
State work to be performed and purpose of building (By Floors) r '��
Remodeling Addition Rep No. of Stories
Size Septic Tank ] 0 0 Type of Tank •? Capacity Gas r-4
Feet of Drain Tile / _ Dist. Feet of Tan or Drain Field from Well 11
Nature of Water Supply: City—Well Size of Soakage Pit
( Signed)
No . 7 H
Date
ie.gr
Notary Public, State of Florida
Street_0e' _
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
ice or notices as are
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public n
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to b p led un' a this permi re
licensed by Miami Shores Village. �„ "(
�
t p y .,,-,
( Signed) T -_ .e_
Master ' umber.
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
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
p
'(
i✓
/ M
V
CHECK
� r_[ 1
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
•(
/
75
CHECK
,1 a
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 V\.\. _L2- fVL4r_l 1 C 1 \J _,__ No Street
Amount of Permit $
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
r
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engineer g
Employing Plumber's Name v 1[
g "7 Block 1.� _ Subdivision
Location and Leal Description Lot , C
Street and Number where work is to be performed —No _ � ,_: ' 5treet.+�
State work to be performed and purpose of building (By Floors) r '��
Remodeling Addition Rep No. of Stories
Size Septic Tank ] 0 0 Type of Tank •? Capacity Gas r-4
Feet of Drain Tile / _ Dist. Feet of Tan or Drain Field from Well 11
Nature of Water Supply: City—Well Size of Soakage Pit
( Signed)
No . 7 H
Date
ie.gr
Notary Public, State of Florida
Street_0e' _
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
ice or notices as are
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public n
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to b p led un' a this permi re
licensed by Miami Shores Village. �„ "(
�
t p y .,,-,
( Signed) T -_ .e_
Master ' umber.
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.
f �t , e/x/ -
r - v
e T ei + eN Grv_s• f.f tee r.v
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