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1065 NE 94 St (5)- ELECTRICAL PERMIT A N° PLUMBING `.vner of Building _. - l{ > _ I `s. � , NAME 7� i .Architect and /or Engineer AMOUNT NAME NAME RECD. PAYMENT ACCT. DEPT. 205 ADDRESS LICENSE NO. ADDRESS Contractor or Builder_ », Proposed Location i h 1 ` 2-r � 4 LOT BLOCK ,.' SUB - DIVISION Y This permit is issued to ( , i) " "" " =;-A. To the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and regulations of the building department of Miami Shores,. Vil age. This permit may be revoked at any time upon the violation of any provisions of said laws, ordinances or aegulations, or upon ij' chafge in the plans and specifications unauthorized by the building inspector. ADDRESS MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 1 1 NO. STREET In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the application and n s and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of Florida, all the building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores Village. 1 1 , +" " Dated , 19__ _. (SEAL) 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 made when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. LICENSE NO. INSPECTOR 0 , �, ft'AL PERMIT A N° 205 PLUMBING Owner of Building NAME ADDRESS Architect and /or Engineer NAME ADDRESS Contractor or Builder NAME ADDRESS LICENSE NO. Proposed Location LOT BLOCK SUB - DIVISION NO. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 19 This permit is issued to ` _' t 4.,r______ To the building above described, as per application, Plans and Specifications heretofore filed in this office. This permit is granted upon the express condition that all facts stated in the application are true and that the construction complies strictly with the plans and specifications submitted, and in accordance and compliance with the building laws of the State of Florida and with the building ordinances and zoning laws of Miami Shores Village, and rules and regulations of the building department of Miami Shores Village. This permit may be revoked at any time upon the violation of any provisions of said laws, ordinances or rules an egulations, or upon ng cha in the plans and specifications unauthorized by the building inspector. I .; I { AMOUNT RECD. PAYMENT ACT. DEPT. In consideration of the issuance to me of this permit I hereby agree to the proposed construction in strict conformity with the plans and specifications thereof heretofore by me submitted, and in compliance with all provisions of all building laws of the State of building ordinances and zoning laws of Miami Shores Village and all rules and regulations of the building department of Miami Shores 19 ,1 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 Bottid. A re- inspection fee of $1.00 will be made when stich re- inspection is made necessary by improper notice for inspection or faulty materials and /or workma Dated_ LICENSE NO. STREET INSPECTOR application and Florida, all the Village. (SE L Date Time Type Insp'n lOrn Permit No. 111 L 20U3 S rj Name Address IOC `, �r. I4s \— Company - V ✓/Len Phone # c)"i F O 3c1 �. I For Inspector: Nam. ; ate Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Budding Inspection Request Name MIAMI SHORES VILLAGE BUILDING DEPARTME T 305- 795 -2204 0 ks Building Inspection Requ Date Type Insp'n Um c�l COOS RCX.191 Permit No. P I - - lobs 14E. G 4S Address M Q' lQ yn Company aqto r 6 , Phone # )s (.s- ` 1 -K 3q ` For Inspector: P i 11 Z15 Approved Correction Re- Insp'n Fee Time e 3 .. Permit No ' Owner's Name and Address L_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 1;-- 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. Bs. My Commission Expires Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot__S! Amount of Permit $ -- 41 (Signed) No / Block ----- Subdivision Street �____I Street Street and Number where work is to be performed —No. State work to be performed and purpose of building (By Floors) New Building Remodeling Addition `.airs No. of Stories. Capacity Gals Size Septic Tank Feet of Drain Tile Di' P Pet of Tank or Drain Field from Well Nature of Water Supply: City —+W Size of Soakage Pit. (Signed) 9-0 /06S" t)iL 4,eo 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 otices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be rmed under is �ermit, as are licensed by Miami Shores Village. Notary Public, State of Florida aster Plumber. STATE OF FLORIDA, COUNTY OF DADE. ��� Before me, the undersigned authority, a notary public, duly authorit�d 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 CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / CHECK 3 .. Permit No ' Owner's Name and Address L_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date 1;-- 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. Bs. My Commission Expires Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot__S! Amount of Permit $ -- 41 (Signed) No / Block ----- Subdivision Street �____I Street Street and Number where work is to be performed —No. State work to be performed and purpose of building (By Floors) New Building Remodeling Addition `.airs No. of Stories. Capacity Gals Size Septic Tank Feet of Drain Tile Di' P Pet of Tank or Drain Field from Well Nature of Water Supply: City —+W Size of Soakage Pit. (Signed) 9-0 /06S" t)iL 4,eo 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 otices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be rmed under is �ermit, as are licensed by Miami Shores Village. Notary Public, State of Florida aster Plumber. STATE OF FLORIDA, COUNTY OF DADE. ��� Before me, the undersigned authority, a notary public, duly authorit�d 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. 1 P; * rk done ddress of work /6 Owner 26./de Sotj< alik Drainf Plumbing - Final When reaLly Received by„ Date --------- Time PLUMBING - IlfSPECTION n ,)"-• ? 4 Permit No. Gas RouFh :2`," t • L ■ TOD out /4 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 building during progress of work. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name and Legal Description Lot Amount of Permit $ STATE OF FLORIDA, 1 ss. COUNTY OF DADE. APPLICATION FOR PLUMBING PERMIT Subdivision S treet ,� {r---- '�- -� - - -- New Building Remodeling Addition Repairs No. of Stories Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) Size Septic Tank _ ' TT ,,,of, Tank Feet of Drain Tile Diet of Tank or Drain Field from Well Nature of Water Supply: City —'! Size of Soakage Pit 1 � -U - (Signed) / c -L U'✓N2 � a " f� 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 under signed agrees to employ only such sub - contractors, on work to be performed under t isfpermit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to 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 MIAMI SHORES VI LLAQ E PLUMBING INSPECTION DEPARTMENT / O ( Block (Signed) Capacity Gals. 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. Date 4 1 Street administer oaths and take Street _s:. Notary Public, State of Florida 7 be kept at • "J a Master Plumber. acknowledgments, personally CLOSETS BATH TUBS SHOWERS LAVA TORIE SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING F OUNT'NS TOTAL FIXTURES LIST df CHECK / 4 / / �, SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LI ST // - CHECK r....'" 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 building during progress of work. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name and Legal Description Lot Amount of Permit $ STATE OF FLORIDA, 1 ss. COUNTY OF DADE. APPLICATION FOR PLUMBING PERMIT Subdivision S treet ,� {r---- '�- -� - - -- New Building Remodeling Addition Repairs No. of Stories Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) Size Septic Tank _ ' TT ,,,of, Tank Feet of Drain Tile Diet of Tank or Drain Field from Well Nature of Water Supply: City —'! Size of Soakage Pit 1 � -U - (Signed) / c -L U'✓N2 � a " f� 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 under signed agrees to employ only such sub - contractors, on work to be performed under t isfpermit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to 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 MIAMI SHORES VI LLAQ E PLUMBING INSPECTION DEPARTMENT / O ( Block (Signed) Capacity Gals. 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. Date 4 1 Street administer oaths and take Street _s:. Notary Public, State of Florida 7 be kept at • "J a Master Plumber. acknowledgments, personally �v. -Olt CLOSET• BATH TUB/ SHOWER• LAVA- TORIES SINK• SLOP SINKS LAUNDRY Tuna URINALS CATCH mA•IN FLOOR DRINK NO DRAIN FOUNT' NS TOTAL FIR TI RE• CONTR. LI T E - — l CHECC K -_ SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H DEEP WELL SPRKLR. SYSTEM SW IM•O POOL i CoNre. LIST I —h CHECK Penn, No. 7 0 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT .4ppliiatllnl is hereby mode for the approval of the detailed statement of the plans and specifications herewith subr ...a for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of MI -! Shores Village, Florida, a,�d all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic• of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec flcatlons must be kept at Building during progress of work. `..)wner's Name and Address_L-C. — .egist Architect and /or Engineer :mploying Plumber's Name / 2 114 !_ .. _.. Location and Legal Description Lot Block Subdivision.__..._. State work to be performed and purpose of building (By Floors)__.:_.__ ... __..___... _ —4s:...k- New Building ........... __._ . .. ......... ..... Remodeling_____.._ __ Addition Repairs No of Stones Street and Number where work is to be performed —No ...Z0 G r Street ,5o /7/ — No No.! © .___ Street. Street,.. . 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 $ 1. Cr° (Signed)_ The undersigned applicant for this building permit does hereby certify that he understands under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws died with the provisions thereof, and will require similar compliance from all contractors or performed under this permit; and will post or cause to be posted for inspection on the sit required by the Act. The undersigned agrees to employ only such sub - contractors, licensed by Miami Shores Village. STATE OF FLORIDA, } ss. COUNTY OF DADE. My Commission Expires (Si Capacity ^ .ale Plumbin:; Inspector and accepts his obligations as an e n, lover of lobo Florida Permanent Cum lenient, and 11as contractors employed 1 the work such publ' k to be • e rm 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 sane, and tiut all acts. therein by him, stated are true. Notary Public, State of Florida in p b° no icrr rs ar Mast./ Plumber. iu . Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take eckmowledgments, per;.n ; . ppearet, NOTE: A re- inspection fee of $1.00 will be made when Nisch re- haspeclloo 1s mede-neoessary by Improper notice for iuspert!on, to town) materials and /or workmanship. ❑ PERMIT N? 15980 BUILDING ELECTRICAL PLUMBING ROOFING Owner of , Building MIAMI SHORES VILLAGE, FLORIDA ❑ Work to be performed under this Permit Architect Contractor or Builder .. Legal Lot II Bl. Description Address of Building CO RACTOR OR BUILDER Signed• Subdi- vision Value of Project $ 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. In consideration of the issuance" to of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the pi • ns, drawings, statements- Or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibilfty _ler° a work done by either, myself, my agent, servant or employee. tiod BY DATE AUTHORITY Contractor's License No Amt. of Permit $ f 195 BY Permit No. - - -2-, _k . Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the uilding 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 No. _ _4 /0 64 - .. �" . ___ Street A ' ?9 Registered Architect and /or Engineer -- - - -- ---- -- Employing Plumber's Name /1 1 A 1 SE E __ fl Size Septic Tank r Feet of Drain Tile2 i�._4�`� Nature of Water Supply: City— Well Amount of Permit $.____ STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)_ Date ApRiz / 1%4- Street_ Capacity Gals My Commission Expires Notary Public, State of Florida (Sr Location and Legal Description Lot Block Subdivision ....... __________ ____.__. Street and Number where work is to be performed —No f Str :. ° �f State work to be performed and purpose of building (By Floors)._ _ - - - -- - e New Building--_- ______ Remodeling__.___ ____ Addition.____.__ Repairs . 1.0■""' No. of Stories _Type of Tank ist. Feet of Tank or Drain Field from 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 el . oyed 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 wor .-. ch .ublic notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contra work to p - .> m 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 imposes 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 /ca workmanship. CLOSET. BATH TUee S HOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tubs U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N5 TOTAL FIXTURES CONTR. UST 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. - - -2-, _k . Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the uilding 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 No. _ _4 /0 64 - .. �" . ___ Street A ' ?9 Registered Architect and /or Engineer -- - - -- ---- -- Employing Plumber's Name /1 1 A 1 SE E __ fl Size Septic Tank r Feet of Drain Tile2 i�._4�`� Nature of Water Supply: City— Well Amount of Permit $.____ STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed)_ Date ApRiz / 1%4- Street_ Capacity Gals My Commission Expires Notary Public, State of Florida (Sr Location and Legal Description Lot Block Subdivision ....... __________ ____.__. Street and Number where work is to be performed —No f Str :. ° �f State work to be performed and purpose of building (By Floors)._ _ - - - -- - e New Building--_- ______ Remodeling__.___ ____ Addition.____.__ Repairs . 1.0■""' No. of Stories _Type of Tank ist. Feet of Tank or Drain Field from 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 el . oyed 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 wor .-. ch .ublic notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contra work to p - .> m 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 imposes 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 /ca workmanship. -�' CLOUTS BATH TUBS aNOW[Rg LAVA• TORIES S SLOP SINK[ LAUNDRY Tug[ URINALS CATCH BASIN FLOOR DRAIN DRINK NO FOUNT' NS TOTAL FIETUR[g CONTR. LIST CHECK SEPTIC TANK SSW ER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL •PRKLR. SYSTEM SWIM'O POOL cL lrr 32' CHECK Permit No. ._ a (5. d — _ -__.— 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 Chuck K i 111 n g S wo r t h No Street -.� Registered Architect and /or Engineer Rose Septic Tank Co. 887 -5V4 E mploylng Plumbc 's Name F .0 • $0 X 344 Nf a.._,., e.,.�..�...,.+.,...... itt�at.._. ...._ ::......._..e ..- ....,,_, _ BIKE Street and Number where work is to be performed —No 1065 N.E. 94th s t r e e tg State work to be performed and purpose of building (By Floors) __. New Building.. - - -_ _ ------- •-- .- -• -_ -. Remodeling____ _ - -___ __ Addition Location and Legal Description Lot. Amount of Permit $ $6 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Subdivision.________.__ Repairs No. of Stories. . ......... -- ^-- -- •_• .... -..._-__ --__Capacity Cala'__-._.- 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. (signed) Ti_�a1�`2� ` I� 1 `1 (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 6968, 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. STATE OF FLORIDA, 1 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 be has carefully read the foregoing application, and that he did sign the same, and thst all facts therein by him stated are true. M Commission fires Notary Public, State of Plaids NOTE; A re- inspection fee of $1.00 will be made wham oath reaupsotios it ssads•nsasaary by Improper nodos fa lespaction, or faulty materials sad /a wvrl®snabip. 7 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 11/19/2002 Applicant: ALICIA Owner: MANGHAM JOB ADDRESS: 1065 Contractor JOHN BUSTA Local Phone: 305 - 219 -9699 Parcel # 1132050120100 NE 94 JOHN BUSTA ROOFING INC. 305 - 757 -2728 300 N.E. 91 STREET MIAMI SHORES, FL 33138 PAY c Ll! r TO THE 7 I/ ORDER OF /9/4/27.7 S Bank ofAmerica, ACH H/T 063100277 FOR /I�.4N'hifilJ 11'00175311' 1:06 3 100 2 7 71: OC Building Permit Permit Number: BP2002 -1994 MANGHAM ALICIA ST Contractor's Address: 300 NE 91 ST Legal Description: KIRBYS ADD TO MIAMI SHORES Fees: FEE2002 -6572 FEE2002 -6574 FEE2002 -6575 Description Building Permit Application Fee CCF Building Permit Application Fee Total Fees: Amount $60.00 $1.20 $60.00 $121.20 Total Fees: $121.20 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 5/18/2003 Construction Value: $1,400.00 Work: ROOF TILE REPAIR If there is no permit oackaae accessible on the iob -site for inspectors to verify, there will be no inspections. Re- inspection 1. Page 1 of 1 PB 41-44 LOT 10 LOT SIZE 75.000 auipment or device described in the application herefor in strict compliance with all any plans, drawings, statements or specifications that may have been submitted to `.; :done in compliance with such ordinances or if the plans are changed without 5r builder named above assumes the responsibility for a thorough knowledge of the in the statements or specifications and that he assumes responsibility for work done ppliance with all ordinances and regulations pertaining thereto and in strict conformity 1 .11age. In accepting this permit I assume responisibility for all work done by either Florida >di Edition 2002 High ' ocity Hurricane Zone Untiprm Permit Application Form. Section A (General Master Permit No. Process Co Name-7;M/ EOM Job Address /C S 1E9 ROOF CATEGOR ■ ❑ Low Slope C Mechanicalik Fastened Tile tar /Adhesive Set Tile ❑ Asphaltic El Metal Pa Shingles El wood Shingles /Shakes Shingles C Prescriptive BUR -RAS 1 ROOF TYPE ❑ New Roof ❑ Re- Roofing ❑ Recovering ■ Repair ❑ Maintenance . ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 9C . 96 Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. C,� 154 Of les �-I JJ 1 i i 1i _ (TiT"!Tf1il - 1 1 1 1 1 t 1 fl 1 f ii li l 1 i T mTTlT1 j( fl i I� i! 1= 3! i I i '� Ti"Ti - t - 1 - - "l T J. = .1J L3H_ i Tii!_i'iiii - ] 1 1 11 1_ -1 r- ]�� i t.1 I I i i T 1 T i i 1 rt I I. 1 1 I I I i 1! 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TT Th y1 T1 :-I i_J _1_1 r1l11 _1 1111 1 t l i i 1 rnm i - i i I T i TI T1 i 1 E1-14-1-1 1 i t l WI 1 ]iL 1 -1 - 1_ _ _ - _______J_l___1.iJ_ _ _ - - _ : I: _ - ) _ -i -- ` J_ i - 1 i1j -j i� I`I i l ]i`1= s - J _i _ _. 1 1 1 1 1 1 ! 1 1 1 1 1 - - - - - , _ -I- _ = _.1L _ _ : - 1 11 -1! ! L TI i 1 I 1 t _ _ } 3_ J 11 11-1 ]T1 J _ - �- - -- : *----- " 1-- :_ - ,:±1 -- ±17-1:1 - �_ _ -- _ _ _1_ iriTl - J_1_,_ F L L. - I- fJ_ . 1:1 r -F-j I l_1_I Florida >di Edition 2002 High ' ocity Hurricane Zone Untiprm Permit Application Form. Section A (General Master Permit No. Process Co Name-7;M/ EOM Job Address /C S 1E9 ROOF CATEGOR ■ ❑ Low Slope C Mechanicalik Fastened Tile tar /Adhesive Set Tile ❑ Asphaltic El Metal Pa Shingles El wood Shingles /Shakes Shingles C Prescriptive BUR -RAS 1 ROOF TYPE ❑ New Roof ❑ Re- Roofing ❑ Recovering ■ Repair ❑ Maintenance . ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Steep Sloped Roof Area (SF) Total (SF) 9C . 96 Section B (Roof Plan) Sketch Roof Plan: Illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. C,� 154 Of les ELECTRICAL TYPE; Minimum Fee QTY. TYPE: Dryer QTY. TYPE: Outlet, Appliance Q'rV. TVPE: Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton ' - Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20-4- Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition _ Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE. Condensate Drain QTY. TYPE Generator QTY. TYPE: Refrigeration, Tons ()TN. A/C Central, Tons QTY. Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump and Abandon Bath Fan- Vented, # Fireplaces, Number of ' - Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE: Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE: Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap -Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap ' Pump, Sprinkler `--- Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) L CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) . $3.00 per page (Scanning Fee) 'Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE 4 ct — a — Z— LI PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ r _ l) (sq.ft. = x/1000 x ¢.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) PERMIT APPLICATION CHECKLIST ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OF A PPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 http : / /www.miamishoresvillage.com Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION. TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8' EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 6: Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE QF FLORIDA COUNTY OF MIAMI -DADE 4e,r l is Rs . /14■_ IYl iclh P r ryl y 14 �1 0�,�/ */-.-9 Signature of Owner Print Name w subscribed before me this 1 " day of • Signature of '' • - Y " : "'a• LORRAINE KELLER SEAL: ?�N � Notary Public - State of Flo, • My CommissionExpiesApr16, Commission DD 10972. ded By National Notary As. Personally known ' OR, ' . a ced I enb ication Type of Identification Produced: Signature of Contractor / Qualifier PERMIT APPLICATION IDA,..COUNTY OF MIAMI -DADE Print Name m om to and subscribed before me this , day of2 et SEAL: - State e tI /ONE KELLER No tary Public - State of Florida • I My Commission Expires Apr 18, 2006 Commission # DD 109725 '.r•• Bonded By National Notary Assn. 3 1 Personally known OR, Produced Identification Type of Identification Produced: CONTRACTOR Name � /�s \J ,�j LicenseNo.UIV a4z a u Address c3a - 9 /CP Telephon 4/ ciP Fax?/Y:2�s-j . 2-72z f /9 J / Qualifier Nam t _, ,ql�/J a/ 54 PROPERTY OWNER Name , �/ Ja�� t/�► tL T7 /� �., �/n ,(/� AGAi A 0 �"[!1 Address /& r: Home Telephone 303-- 75 f/„ 9(/ , / T �/ Business Telephone Repair Fax Alteration Interior TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. ,Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. A PPLICATION t Job Address: /06-5 9� • Address Lot Block Apt. Folio Number Description of Work /64 //A5 Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG - e 81n /g„_ - W , � 4 , Linear Feet Lt1c7 7Y� , ., � Square Feet 4 Units Floors d Value of Work / gig . Bldg Value Kir Y Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No /)7440/ s /rL City State PERMIT APPLICATION c ' / 9 3 Zip ENGINEER Name License No. Address Telephone Fax Date Legal Description 4 7- 3 l 1v / f. Historically Designated: Yes Owner/Lessee / Tenant ,Y) I k - , fl A/S »Y1-N'L Master Permi Owner's Address Contracting Co. s4 !� �./ij .✓ ��Q�%r •v 7�' Qualifier 74 / J. / : 'r (er State # Municipal # Architect/Engineer //t) Bonding Company Mortgagor WORK DESCRIPTION Square Ft. Estimated Cost (value) /6 6" 9y S /- /�/�/j paY P • ' CIAL NOTARY / J _ ' .. r , EOM E I : • . I , . .,;; na rQa I 010 —.1:i''. de '•R . CC981.r7 j •MMISSION 20E EXPIRES ;►` Notary a o • er and/or Condo President My Commission Expires: FEES: PERMIT /, 7 RADON PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address / S N Tax Folio APPROVED: Zoning Building Mechanical Plumbing C.C.F. NOTARY Phone C3o5") Address /I/1/ Z/f SSY" SS# 3Phone 3 ar-- S'S/ -f1'5j Competency # 01/96 Ins. Co. Address Address Address .V Permit Type (circle one): BUILDING ELECTRIC L PLUMBIN MECI ROOFING PAVING FENCE SIGN e Electrical 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 that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. *Let COMMISSION N , �iii,z; UMBER D - 45,D Y • CO981872 A ' • F Fin ,,,_ N EXPIRE Date Notary as to Contractor or Owner- Burldei My Commission Expires: TOTAL DUE Engineering A Suburban Propane, L.P. Company 1491 N.E. 130th Street North Miami, FL 33161 Dade 305 - 891.8393 - Broward 954 - 923.6432 1- 888 - GAS -4576 http://www.suburbanpropane.com /ZU/ 3 0 ,cee/- o C -, Mind< J'/I'C f0 l,.9 a00 Q sfo si pp \,\ )4' ) PAP e)P' riP"- 24-°'''''' l P / / /1171 /44&,cAS L �20;.,MIRl1CLE !.MILE:' SuITE T: i . i COR,AL':,vABI ES'�:tF.l'A. 33139 0n0•[•t (3051.44'4'7-...700 "'• .i -.��', :'tft qtr. i .t ' i ,� 5 nit WO ;(3051.77➢ - :32.11,' 'FAX: 1300,1 8.4 1 rr I (•l:i, f o r r ;c vAji 'r fY .t SU RVE:Y:'OF,: J ..SUBoivIs ION' ACCORDING TO, ;THE PLAT THEREOF AS j . 000RDCD 1 IN PLAT ° 800K N PUf�4LIC RECORDS ,OF �''1•"4 RATE. `' l0 ' AIZC.I'SO'1JOSI•; l'rofo lono1..Land '3talo "of Florida.:`. (Nal Valid Unless: `: Irrii I horsby: codify ; that this boliofoe. surveyed ..and o Society of Prolos ' r'e no sncroo menls; ;l''`' -.THE F IA ,INSURANCir r ATL' ;til ; ; . ; :sEP 30;1,072 AND RLVISED MARCH 18;; • :3 4: 1 . PU 0 LISHED1BY.THEUNITEJ,STATC' ;:•:;.. DEPARTMENT OF HOUSING AND UFB11,i '` ' DEVELOPMENT DELINEATES 'THE H El�t:ir �J:•.' L :::SCRIBi D LAND TO BE SITUADED W;dI r ?;tt.. 1 THIS IS A FL;iOD HA2f\Fat: ' . ZONE. • : . ':; • =r j ub!l a "Propafre: LP1 Com 13Oth i Street Brd'ward i 5 954 923- 1188 �,G 5;76'.; r " httP / WWw.subU rpnnpropane com' • r t, ...? +r 04 i . nr `�� �4 • rr'' trt I i S , {7 { .�.�li t' i4w T t, , .. • 7., • t .1 r‘h ') 0. I 1 4...; 1 f• 1 r r1 .r } .. )( t :5 • `• • ' Aft! ;, : .2 1 . 12; :di V6 fr;Fti.01:i.S UAkftifi . rrkb tiiL‘101 AR CRO8d0 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 4/7 B lding Inspection Request 7 Date ( is Thpe Ti = Type Insp'n Fro 1 I ( Permit No. P1 03-(S r Name Approved Correction Re- Insp'n Fee Address CYO S Company Phone # For Inspector: It I & r ate qq,