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1080 NE 95 St (3)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. - `' ' 9 " No. Street Registered Architect and /or Engineer Employing Plumber's Name - ' No. c _Street /V _.:_' _ _. _ -. _._. i Location and Legal Description Lot _ "- Block Subdivision .A (_ !fh_Y F " Street and Number where work is to be performed —No °' Street__ - State work to be performed and purpose of building (By Floors) New Building CONTR. LIST CHECK CONTR. LIST CHECK CLOSETS BATH TUBS SEPTIC SEWER TANK CONN. SHOWERS DRAIN FIELD ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling Addition_ ______. _ _ ___ Repairs_.- _ ._ No. of Stories ._ LAVA- TORIES SOAKAGE PIT SINKS URINALS GREASE TRAP SLOP LAUNDRY SINKS 1 TUBS SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL Type of Tank - Dist. Feet of Tank or Drain Field from Well Size Septic Tank Feet of Drain Tile Nature of Water Supply: City—Well. _- Size of Soakage Pit .. Amount of Permit $ --- --- _ -__ -- ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him it 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. ( Signed) CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS Capacity Gals. - Date. -- - - - STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the the above described construction, that he has carefully read the foregoing application, and that he did sign the salve, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Plumber. 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. TOTAL FIXTURES Permit No. CONTR. LIST i CHECK CONTR. LIST CHECK CLOSETS Application is 1:ereby 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 . _... Registered Architect and /or Engineer Employing Plumber's Name 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 Repairs _ No. of Stories _ SEPTIC SEWER DRAIN TANK CONN. FIELD Amount of Permit $ BATH Tues SHOWERS ss. LAVA- TORIES SOAKAGE PIT MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT SINKS GREASE TRAP SLOP SINKS Type of Tank LAUNDRY Tues No. Street No. Street URINALS SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW I M 'G POOL Size Septic 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) CATCH BASIN FLOOR DRAIN (Signed) Date. DRINKING FOUNT'NS _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 he 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. My Commission Expires Notary Public, State of Florida Master Pltunber. TOTAL FIXTURES STATE OF FLORIDA, ? COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to nu: 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. Lo7 Permit No ®off MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 et building during progress of work. �^ Owner's Name and Address P o ,u,S� � NO 0 (� � t_ Street...�� Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot. Amount of Permit $ 111. Bleck Street and Number where work is to be performed —No 0'5 hF t , Street_.. ➢ l�� �Jr State work to be performed and purpose of building (By Floors) _ elr J 304 New _ _ -- Remodeling_____ ___ __ Addition._ _ Repairs Size Septic Tank_-- Type of Tank r\C ... Gals...- •- • - - -• -- - - - -•- •• - -••- Feet of Drain Tile 3 44V Dist Feet of Tank w Drain Field from Well..---- _ .-- __._.- .-- -_..._ - - —• -- Nature of Water Supply: City —Well. Size of Soakage Pit ( Slgned)_ 1 ,11, Fg.` Date ..= ... ' _ .4— ._. V No. of Stories ....... 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 Cenerall 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 worn to he 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 cure required by die Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as aro licensed by Miami Shores Village. Master Plumber. - - STATE OF FLORIDA, 1 COUNTY OF DADE. t 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 be is the •__ -._ .. _ --- •---- - -.... _ _... —. of the above described construction, that he has carefully road 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 seek r. Mweotioa it made by improper notice for Inspection, or faults materials and /or weelonanship. CLOSETS BATH Tuns SHOW[RI LAVA. w S SINKS GLOP SINKS LAUNDR TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK NO FOUNT 'N[ TOTAL FIXTURES CONTK. LIST CHICK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL 8 SYSTEM SWIM'O POOL Gown. LIST �- CHICK Lo7 Permit No ®off MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 et building during progress of work. �^ Owner's Name and Address P o ,u,S� � NO 0 (� � t_ Street...�� Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot. Amount of Permit $ 111. Bleck Street and Number where work is to be performed —No 0'5 hF t , Street_.. ➢ l�� �Jr State work to be performed and purpose of building (By Floors) _ elr J 304 New _ _ -- Remodeling_____ ___ __ Addition._ _ Repairs Size Septic Tank_-- Type of Tank r\C ... Gals...- •- • - - -• -- - - - -•- •• - -••- Feet of Drain Tile 3 44V Dist Feet of Tank w Drain Field from Well..---- _ .-- __._.- .-- -_..._ - - —• -- Nature of Water Supply: City —Well. Size of Soakage Pit ( Slgned)_ 1 ,11, Fg.` Date ..= ... ' _ .4— ._. V No. of Stories ....... 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 Cenerall 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 worn to he 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 cure required by die Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as aro licensed by Miami Shores Village. Master Plumber. - - STATE OF FLORIDA, 1 COUNTY OF DADE. t 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 be is the •__ -._ .. _ --- •---- - -.... _ _... —. of the above described construction, that he has carefully road 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 seek r. Mweotioa it made by improper notice for Inspection, or faults materials and /or weelonanship. e d� 3 ke_dc oom o u,se, I;vi oc:0 O ?LW :ZING, {C � P.O. 30K M4L 7 ( 300 3) 7 —a e ° . PAULsE N S t p F ltic 10 RE,, IA tA 1 s 2 E 1 IM Date B a2 Owner's Address Contracting Co. WORK DESCRIPTION APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE tg Job Address 1 & FO /i , ?SS / Tax Folio /1 3 o5o 0 Description 1Tistorically Designated: Yes No / Tenant ' 11)1) Y`} b Master C gilt # t-' U � o��� ✓d' ILO .60 NIL AI 1 DC AJ � 14� � Add s �i, a Qualifier , ' . J fit L �r S S# �� - - ' �! . �� o /() State # ((OMunicipal# Competency ' J( ��l�,� Ins Co. , FEES: PERMIT 7o RADON Phone - 2 4 e ' Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN gi Aco 4 gtniee 040 Square Ft. Estimated Cost (value) f 4/DD G 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 contrac stated. O �.r�0 `���\ C > " :: ° T NJS "'°''?�'f' :,, 'S ,US7 7 > . e, { di'& l C / J Signature of owner oft • e� Date Signature of £ , : c Vic'• � Date =o. NCC 3843 % tea .�1sc�::r Notary as to Owner an 86► t Date My Commission Expires: C.C.F. I ^ l ` NOTARY TOTAL DUE t 42. � Building Electrical Plumbing Engineering_ ITEM BATH TU3 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE _ BIDET LIGHT OUTLETS CENTRAL HEATING DISTIMASHER RECEPTACLES A/C (WINO) DISPOSAL SERVICE TEPCRARY A/C (CENTRAL) 4 "1(u iv 1 ' y DRINKING FOUNTAIN SERVICE SIZE IN MPS XET WORK 0 tiJ2 S„ a,02 FLOCK DRAIN SERVICE REPAIR/METER (MOE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING IHTERCEPTCR RANGE TCP UtGERGI;UR0 TANKS LAVATORY OVEN ABOVE GRU M TANKS LAMP TRAY • WATER HEATER U.F. PRESSLRE VESSELS CLOTHES WASHER MOTORS 0- 1 H' STEAM BOILERS SI -LOWER MOTORS OVER 1- 3 FP HOL WATER BOILERS SINK. POT /3 COMP. MOTCRS OVER 3- 5 FP MECHANICAL VENTILATION SINK. RESIDENCE MOTORS OVER 5- 8 FP TRAIISPORT I FIG ASSO DL. I ES SINK. SLOP MOTORS OVER 8- 10 If ELEVATORS/ESCALATCRS TEMPCRAAY HATER CLOSET HONORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MJTCRS OVER 25-100 FP COOLING TOWERS WATER CLOSET MICAS OVER 100 FP VIOLATION INDIRECT WASTES A/C WIt001 - REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS "'` J LAWN SPRINKLER -WELL SPECIAL PURPOSE / SWIMMING POOL OUTLETS COWERC I AL PLATER SERVICE SIGN TL_ES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY - SEVER SIGN TIME CLOCX ITILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS JRAINFIELD, 4' TILE/RES. VIOLATION 'UMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. _ LATCH BASIN T I SCHARGE WELL )0ESTIC WELL • iREA DRAIN LOOP NUT OLAR WATER HEATER IRE STAN:PIPE 001. PIPING AWN SPRINKLER SYSTEM AS RANGE ETER SET (GAS) AS PIPING 1 ~ ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT RUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL 1 20250 N F 15111 COURT DAM. 1305) 652•13O4O NORTH MIAMI RFACII. FL 33179 BROWAg 13051 784.0489 Residential Air Conditioning Co. -rO NEfr 1 Pre P4 ! p ared toDA E L ALBERT HEISLER Addling- S__S ffi � 1111 iiill11111111 Milli01111111 I Q � SI ■IIIIIIIIIIIII O41 t TIM cri. ; nt_1Eht NEIS1 fl i1n.tIir1n111i.i1 lair Conditioning Co. 91'7;' fir 1 [inot. 8328040 rf,•n l f f minfnf nr nr;f 1 ri. 111 79 nr wnmu: 13091 764 0499 OOS • Prepared fo 1. � A.4 P Address ..�. - = 1 -� . ? • • g ; rRj, • -04 • 1 71 1;r) DI' U l��'hu S 1-) /��1 >> Y/(4/C ,X0,0 �ilti���� ;Z aLQ. c IDwo NE � �} fto, ore r Permit No 5 7 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, 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 L .5.. ..fit No 1 G 0 Street Registered Architect and /or Engineer Employing Electrician's N ti..l.C........ • No 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 Repairs No. of Stories Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L (Signed) .Meal Moulding Electrical- I The undersigned applicant for this building permit does hereby certify that he understands and accepts i ts obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of rida 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 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 subcontractors, on work to be performed unde this permit, as are licensed by Miami Shores Village. / . / Street t4 Electrician. STATE OF FLORIDA, l COUNTY OP DADE. j ss. 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. 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. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'8 FIXTURES NO. LAMPS REPRICE OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIET. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.8 HP NEON TRANS. RADIO C 67 fab TOTAL 4 7(' /D l ' _�- ' CONTR. LIST CHECK Permit No 5 7 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fiu:ida, 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 L .5.. ..fit No 1 G 0 Street Registered Architect and /or Engineer Employing Electrician's N ti..l.C........ • No 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 Repairs No. of Stories Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L (Signed) .Meal Moulding Electrical- I The undersigned applicant for this building permit does hereby certify that he understands and accepts i ts obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of rida 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 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 subcontractors, on work to be performed unde this permit, as are licensed by Miami Shores Village. / . / Street t4 Electrician. STATE OF FLORIDA, l COUNTY OP DADE. j ss. 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. 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. itta MIAMI SHORES VILLAGE 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. 4 Owner's Name and Address vl t Registered Architect and /or Engineer ,,. „,, ... Name and address of licensed contractor... Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT P 2 Date..._..._... No... // r _._... _._.......... ,19'.l �� ._ ..A P ... State work to be done and purpose of building (by floors).-- -_..4. ___...._...__..._....._._ " J t om- -- - e-e Ay- Disapproved (Signed) fr Date -. Building Inspector New Building Remodeling. /' L e)t 4 .. Addition To be constructed of Kind of foundatio Estimated Total cost of improvements $ u— c v Chair:nan Member Member Council Approved Amount of Permit $. Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Repairs No. of Stories Roof Covering Maximum live load to be borne by each floor I hereby submit all the plans rd specifications_for said building. All notices with reference to the branding and its construction may be sent to (,- `� �1 �= •o�l�- -�`L- % . ..''7 .._.. 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 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 subcontractors, on worlf -to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. �P L ( 1/7 -1 l � � Permit No. � Date Read, Sworn to and Subscribed before me. Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Member Member Member Date Disapproved NOTE: A charge of $1.00 will be made for making corrections the Planning hoard. A re inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice materials and /or workmanship. or changes to this application after approval and for no other purpose. to me well known, Date has been obtained from for inspection or faulty 1 SALES AND SERVICE BUS. 758 -3011 RES. 56— 0 0) E 3 Act 4h. a- 4I- v ii - cEi .I LESLIE L. STEPHENS SHORES AIR CONDITIONING, INC. SERVING SOUTH FLORIDA SINCE 1932 P.O. BOX 680385, MIAMI, F.A. 33168 ti W Ls v mZ �;��'� ( V` 0254( Dom; b1 (e -° Ar /4:97$/ 4 nf p bed doll "zr fir- SIB E . MIAMI SHORES S8 . MIAMI LAKES 6;te eN ,}1/ ,L)6