MECHANICALDate A C - /D ` %5 b Address /o69 /Y E 92/ Tax Folio
_ 37.=
Owner / Lessee / Tenant NC' a)f — / 7) 5 TE :T k) Master Permit j
Owner's Address /00 9 /V/E: 94 7 Z/ 2 7t Phone
Contracting Co. e/47S -$ 1/
Qualifier__&( -1 s SS# Phone (. 7 '/
3L4 / r7e'' -.. b c •
State ItageoaltilWgiunicipal # Competency # Ins.Co.
Legal Description
Square Ft 0
Sign
Date
Notary as to Own
My Commission F4pir' -:
** * * *
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE •
* *
FEES: PERMIT C.C.F.
APPROVED:
Zonin
Mechanic
,w
- .
: 411111 . ident
Z
D r C . :. f,
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC376283
MY COMMISSION EXP. APR. 29,1998
*
Address /989 /V GE • / t6
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING
WORK DESCRIPTION i t wo - _ koL__e 6
O./ / 77v21 Qi7 /c / � ( 7 S/s w/s / ;, J /1874 -1
Estimated Cost(value) # 2 " • "
MECHANICAL
ROOFING PAVING FENCE SIGN
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 • I certify that all the foregoing information is accurate and that all work will
be done in com i nce with all applicable laws regulating constru i•n and oning. Furthermore, I
autho ize th above -named contractor to do the work stated.
r�
Signature ••n cto or Owner- Builder
D e : OFFICIAL NOTARY SEA
ANA M FERNANDEZ
NOTARY PUBLIC STATE OF FLORIDA
Notary/ to Co tpA•c►tTjv;!9'_x'0tW
My Commission Expires:
NOTARY TOTAL DUE
Fire Other
Building Electrical
Plumbing Engineering
�/' k- / 4-/
For: Name y' . _ 4 - 4 Z .4---1 ,(J 7
N�
Address /00 9 / ET 7 y
City and State or Province 4 1/ 4 "-// ...51-I4t) £ / > ,-1- -
By: Contractor ...- /\/k// 2 /Co - Al
Address / 9 90 n! &, /z / 9' ,
City /i// /",wl, , i-L4 3; 1S7
Design Conditions
/,.� Winter ../ Q Summer
Outsidedb I'/ >'" °F Insidedb �` e, °F Outsidedb / 6 °F Insidedb . 1-5 _ °F
Winter Design Temperature Difference - °F Summer Design Temperature Difference °F
Room RH .SS_ Daily Range
Heating Summary
Total Heat Loss for Entire House (Line 15) = / CA, £0S' Btuh
Ventilation CFM = '/4 —. Winter Design Temperat a Difference = °F
-2-3
Heat Required for Ventilation Air = 1.1 X ///- CFM X / V/- 4 -- �- °F = /V/
Design Heating Load Requirement = — (house) (Vent) = /(04$ Btuh
Cooling Summary
Total Sensible Gain - '1 Btuh (Calculation Procedure D) Design Temperature Swings
Total Latent Gain + g, & 72 Btuh (Calculation Procedure D) Normal 3° ( ) 4.5° ( )
Total = Sens. + Lat. 39 o8 2 Btuh Ventilation CFM = (// --
/� .acrh -ol 3 E2, u� en ummary
Maki ". "1'"L Mod FAy A►.Ic(K �Ap='dt�} Type .. -. "P �4ST�i t
Heating Input (Btuh) •3 -TkuU Heating Output (Btuh) 1, 4 6 0 Efficiency �Zt.0 ,
Sensible Co. '.. (Btuh)- to Ta ,a - Co S'0 0
( ) I (0)9 o0 Latent Cooling (Btuh) Total (Btuh) y O 2 OO
(a 3 d V
COP /EE SPF I 01 5- l I i ( ) SE.LCooling CFM 1 y C.) Heating CFM 1 2 5
Space Thermostat Heat ( ) Cool ( ) Heat /Cool ( /) Night Setback ( )
Construction Data
/C5-C/'
Windows Floor
Partitions
Doors
Walls / ° ij Basement Walls
Roof Ground Slab
Ceiling /5 ---- &
FORM J -1
Including Calculation Procedures A, B, C, D
Copyright by the
Air Conditioning Contractors
of America
1513 16th Street, N.W.
Washington, D.C. 20036
Printed in U.S.A.
1986
WORKSHEET FOR MANUAL J
Plan No. - /
Date o /- - ? 5
Calculated by ,' 414 .y t )
LOAD CALCULATIONS FOR RESIDENTIAL AIR CONDITIONING
1
Name of Room
Entire House
1
2
3
4
5
2
Running Ft Exposed Wall
.2U I/
3
Room Dimensions, Ft
4
Ceiling Ht, Ft
Directions Room Faces
TYPE
OF
EXPOSURE
Const.
No.
HTI`i
Area
or
Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Btuh
Area
or
Length
Htg
Clg
Htg
Clg
Htg
Clg
Htg
Clg
Htg
Clg
Htg
Clg
5
Gross
Exposed
Walls and
Partitions
a
/-10 °o
b
yO o0
c
En
d
rj
_
6
Windows
and Glass
Doors
(Heating)
a___3 A
_26, fv
5
1
b
Sp (
17 5
c
1(6
/576
d
r
7
Windows
and Glass
Doors
(Cooling)
North
/8
51:2_
XI/
476
972--
3
l
E &W or NE & NW
South or SE & SW
0
/680
—
1
Other
8
Other Doors
9
Net
Exposed
Walis'and
Partitions
a
7A-
2 0
/V
22308
a
—
b
c
d
J0
Ceilings
lG h
-3,
1 a
20(0
'/f5(5
16/3
- -
- -
11
Floors
a
b
12
Intilhntirnl 11TM 23,9
7 6
/80
I/3e2.
/1A.0
13
Sob Tot. Ilhlh Luss = 6+8+9+10+11+12
/& 0110
14
Duct Btuh Loss
15
Total Btuh Loss = 13 +14
1 SIOC
tiuslz
/60 )f'
87o0
16
People a 300 and Appliances 1200
17
Sensible Btuh Gain= 7 +8 +9 +10+11+12 +16
314,7%
18
Duct Btuh Gain I
1
19
Total Sensible Gain = 174-18
3 O
c
- ,
_. ..�._ 1t..14 IU L LVU ...IL 111E LU.,.. . ... ��,...... ......u.,
Calculation Procedures A,B,C,D
Procedure A - Winter Infiltration HTM Calculation
1. Winter Infiltration CFM
O 7 8 AC /HR x / . L Cu. FT. x 0.0167 = CFM
Volume
2. Winter Infiltration Btuh L /
1.1 x / - 7U CFM x 2 3 Winter TD = U Btuh
3. Winter Infil ation HTM v C
L/ 30 Btuh _ 0 0 U Total Window = .23• 41 % HTM
& Door Area
Procedure B - Summer Infiltration HTM Calculation
1. Summer CFM
/`1 AC/HR x 0 8 5 Cu. FT.x0.0167=
Volume
CFM
2. Summer Infiltration Btuh ' /
1.1 x 65_7" CFM x /5 Summer TD = �`/ o 2 Btuh
3. Summer Infiltration HTM
/ O 7 Btuh = /KO Total Window = " 7/ p HTM
& Door Area
Procedure C - Latent Infiltration Gain
0.68 x gr. diff x O Summer
= - 3 2- Btuh
Procedure D - Equipment Sizing Loads
1. Sensible Sizing Load
Sensible Ventilation Load
1.1 x Vent. CFM x Summer TD = O Btuh
Sensible Load for Structure (Line 19) + -i -/ 7o Btuh
Sum of Ventilation and Structure Loads = 34 1 /7 Btuh
Rating & Temperature Swing Multiplier* x / /0 RSM
Equipment Sizing Load • Sensible = 3 4/70 Btuh
2. Latent Sizing Load
Latent Ventilation Load
0.68 x Vent. CFM x gr. diff. = Btuh
Internal Loads =• 230 x =4 No. People + / y0 Btuh
Infiltration Load From Procedure C + 2P. 3 Z Btuh
Equipment Sizing Load — Latent = y(G /2. Btuh
* Refer to Table 6
%)Job Address MO Q / e qv 2' Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
144('{4S e 7 Master Permit # `7�' C/
-/E21-0Phonc,29Li //& :-
J Phone �/ � �
Contracting Co. — ..�����a�� -AOSS . ( c(i / /Address l 9 90 VP, / V/ f A
Owner's Address
Qualifier
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
State # Municipal #
My Commission Expires:
Signature of owner and/or Condo President Date
�v
FEES: PERMIT 75- RADON
Competency # �� 98 Ins. Co. , w 1Y 9r9
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN ECHAN ROOFING PAVING FENCE SIGN
WORK DESCRIPTION �� � 04..k A 2/57746j' ,7v7
,ga(bzo‘liv��� Git&
4i /-7ioq
Square Ft. ,4 v Estimated Cost (value)'
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 AFFIDAVIT: I certify that all the foregoing information is accurate and tha all work will be don in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named cod actor to do the wor tated.
ature of Contractor or Owner- Builder Date
Notary as to Owner and/or Condo President Date Date
:litgag9 tfa ciek: NOTARY SEAL
SANDRA M MONTIEL o
* COMMISSION NUMBER
Q CC401261 R'
7, rc iO MY COMMISSION EXP. ",
`D OFF -0 AUG. 17 19q8
C.C.F. - NOTARY TOTAL DUE ID
APPROVED:
Zoning
Mechanical 1 ' f C Plumbing Engineering
Building Electrical
BUILDING p MIAMI SHORES VILLAGE, FLORIDA
PLUMBING ELECTRICAL
0 PERMIT N° 37387
ROOFING � ❑
Owner of
M Building K Y/
�f
m 1 V Architect
Contractor //� ,�, ,�, ,� " �/
or Builder C/ 2- / 9 -� 4
Legal 14t 9 11
�
Description 1 BI
Bing of / Z Z f' JZ
Building �
Signed•
In cons eration of the issu
pertaining t • reto and in stri
In accepti this permit I
CONTRAC s•'' or BUILDER
Work to Ibe performed under this Permit
Date °2 +0 19�5.i r
Contractor's
License No.
c 9 a rei 5 K
Subdi-
vision /9y p P1
Sq. Ft. !/
Value of OO � Amount of
Project $ I 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 applica-
tion herefor in strict conpliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statemenla of 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 t the contractor • build named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work cov ed) hereby • eth , show . j the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, a
/1 & ,as /J Da /P? 0
(INSPECTOR) BY
permit /agree to perform the work covered hereunder in compliance with all ordinances and regulation
th plans, d wings, statements or specifications submitted to the proper authorities of Miami Shores Village.•
ity for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Date,9j- /v ` 9 ob Address /067 /Y1E 9 ' 'Z42441 Tax Folio
Legal Description
Owner / Lessee / "enant Y /�/& LIJ/ i /�/�Lf"7 5 7 E E(. ) Master Permit #
Owner's Address /00 q /Vi� 94/
Contracting inn _
y fa/C- Address
Qualifier Ze./ // 4 4^--/ / 4S SS# - 0/ Phone C' ?5) 9 — G6S7
r
State #eAC®y ,� nicipal # Competency # Ins.Co.
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one
Address
ELECTRICAL PLUMBING MECHANI ;, 'ROOFING PAVING FENCE
WORK DESCRIPTIO( i o & , ex-2 3 2L/4
/� Via_ s us c�13' /mow
/4194 ) /s2 70A,/ s% c,)/s /eir,t/
Square Pt. Estimated Cost(value)
WARNING TO OWNEZ: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT 131 YOUR PAYING TWICE FOR IM3 ?ROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINAN :ING, 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 acdendum (if applicable). I certify that all work will be performed to meet the
standards of all .aws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL. WORK.
OWNER'S AFFIDAVI ' I certify that all the foregoing information is accurate and that all work will
be done in com• i :ice with all applicable laws regulating constru
auth ize th abcsve -named contractor to do the work stated.
PERMIT APPLICATION FO:R MIAMI SHORES VILLAGE
: BUILDING
Notary as to Owner an or Condo President
My Commission Expir- -:
** *
FEES:
APPROV
* *
Address
Address
P 01
Phone
X959 474E. /4'?
4111
Signature
to
OF ' - IAL TARY SEA
ANA M FERNANDEZ
NOTARY PUBLIC STATE OF FLORID
i • n and oning. Furthermore, I
or Owner - Builder
Notary 4 to Co tral¢tprrDpsp. •`.
My Commission Expires:
* * * * * * * *
SIGN
*
IT RADON C.C.P. NOTARY TOTAL DUE
Fire
Zoning Building Electrical
Mechanical Plumbing Engineering
•
r r f
Permit No I (;
MIAMI SHORES VILLAGE
ELECTR ICAL INSPECTION DEPARTMENT
PPLICATION FOR ELECTRICAL PERMIT
Date. ..S a 7..
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. �/ '/ p
Owner's Name and Address...., F.4 EN 15) 7 No / JO 7 Street_. /Y..E 7' V'S -F
Registered Architect and /or Engineer 4-- d i el
Employing Electrician's Name . G. k. ..C'13..i.u_..Eu.G.47.1•Il`.LC. p No 1'F 1 + 1 Street__ .27.:, J' 1 5 11-
Location and Legal Description Lot ` Block Subdivision
!
Street and Number where work is to be performed —No /..... / �1 E 9' Street
State work to be performed and purpose of building (By Floors) ,L,47 720 x,14/1 / 0, /T/ 6 AI
New Building Remodeling Sc.„ Addition. . Repairs No. of Stories. .2 ,
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground P p
Type of Installation — Conduit X Tubing. _.. B.X.L Metal Moulding
Amount of Permit $ (Signed) ,
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig fns 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 subcontractors 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 Z. to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. as.
(Signed)
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 necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Master Electrician.
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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
3
3
CHECK
v. Ni c
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1 -5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
IST
LIST
/' A
CHECK
0
•
r r f
Permit No I (;
MIAMI SHORES VILLAGE
ELECTR ICAL INSPECTION DEPARTMENT
PPLICATION FOR ELECTRICAL PERMIT
Date. ..S a 7..
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. �/ '/ p
Owner's Name and Address...., F.4 EN 15) 7 No / JO 7 Street_. /Y..E 7' V'S -F
Registered Architect and /or Engineer 4-- d i el
Employing Electrician's Name . G. k. ..C'13..i.u_..Eu.G.47.1•Il`.LC. p No 1'F 1 + 1 Street__ .27.:, J' 1 5 11-
Location and Legal Description Lot ` Block Subdivision
!
Street and Number where work is to be performed —No /..... / �1 E 9' Street
State work to be performed and purpose of building (By Floors) ,L,47 720 x,14/1 / 0, /T/ 6 AI
New Building Remodeling Sc.„ Addition. . Repairs No. of Stories. .2 ,
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground P p
Type of Installation — Conduit X Tubing. _.. B.X.L Metal Moulding
Amount of Permit $ (Signed) ,
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig fns 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 subcontractors 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 Z. to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. as.
(Signed)
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 necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Master Electrician.
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, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
ROOM AIR CONDITIONERS
C. E. HOGAN F. R. SCHREFFLER
Villago of :aaral Shores
jity Hall Liconso Dept.
0050 Z. 2nd :Ai
iarai. Shores, aorida
3car Sir:
260 N. E. 59TH STREET MIAMI. FLORIDA
June 27, 1953
This is a lettor to notify you that )Jr. Otanley Dyckes
of 1009 Z. 94th Stroet, uill be responciblo for any
nose caused by tho hilco 1too ir Conditioner we are
insta13in3 for h:Im.
Signature h;yekos
•
Owner's Name and Address
Registered Architect and /or Engineer
MIAMI SHORES VILLAGE
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and 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.
o
Name and address of licensed contractor.._( 1 % � /C 9 �"
Location and legal description of lot to be built on:
Lot Block Subdivision
Street and Number where work is to be done____ _.._ ._ d -
0
State work to be done and purpose of building (by floors) .=.s. ... �??_lLJ ,` �L� -4 , � C� �' p -;___.'4, ( '
Date
Buildi Ii--
BUILDING INSPECTION DEPARTMENT
clCZ
Remarks (Signed)
Date !S 2
No / Street__
19
A 0
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation g oof Covering
G
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 or 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, 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 i inspectio 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 'contra trs, on wo to be�foffned under this
permit, as are licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. j ss
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 st d e true. 6,
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved
( Signed)
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member 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 Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.