ELECTRICALPermit No...... /.�j�
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, Fio: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
Registered Architect and /or Engin er /
Employing / c a N ;�me....(/ 1 � �/V� S0 /
i/ Location and Legal esofiption Lot �� A
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
Amount of Permit = ...
1
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT /
Date ,,,1 f�J fa
� 4J .... .4 9J Street
/T(//C et) i( C∎z
N0.. 3 $
No Street.. �+
Block ex Subdivision ''d" el:3
Repairs No. of Stories
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation -- Conduit Tubing.. ... B.X.L Metal Moulding
(Signed).!!r v U ..
Street.... C VS
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understarfds and accepts his obligations u 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,_n work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OP DADE Il
ss.
(Signed)
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.
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
0
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
11
W. HEAT.
CONN.
SPACE
H
STRIP
H
TOTAL.
CL
LIST
/ J 1
(/
0
/
/
Y
CHICK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
O. MP
MOTORS
1.8 HP
NEON
TRANS.
RA010
TOTAL
CONTR.
LIST
CHEcR
Permit No...... /.�j�
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, Fio: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
Registered Architect and /or Engin er /
Employing / c a N ;�me....(/ 1 � �/V� S0 /
i/ Location and Legal esofiption Lot �� A
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
Amount of Permit = ...
1
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT /
Date ,,,1 f�J fa
� 4J .... .4 9J Street
/T(//C et) i( C∎z
N0.. 3 $
No Street.. �+
Block ex Subdivision ''d" el:3
Repairs No. of Stories
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation -- Conduit Tubing.. ... B.X.L Metal Moulding
(Signed).!!r v U ..
Street.... C VS
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understarfds and accepts his obligations u 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,_n work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OP DADE Il
ss.
(Signed)
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.
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.
Permit No ° (41 t 3
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oi 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. /f�
Owner's Name and Address. 29 " /°'1 .Rd --7/1 No... .1. 3 Street
Registered Architect and /or Engineer .....IS.iP��
Employing Electrician's Name...E.) / " . . ,..:eiV ... 111 4 - 41 !'f. 3 Street
Subdivisio
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
Location and Legal Description Lot
Amount of Permit $
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date 4 9 — `
Block
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation -- Conduit Tubing B.X.L Metal Moulding
(Signed) PI .DCZK)0
(Signed)
Master Electrician.
jgrie 33e /a
Electrical 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 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. f 's
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•S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
14
W. HEAT.
CONN.
SPACE
14
STRIP
HEATER
TOTAL
CONTR.
LIST
3
.
CHICK
/�
Q, 5tes
1 ,ZJ
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1 -5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
3
I
CHECK
(0 te
5. W
J'.{
..
Permit No ° (41 t 3
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building oi 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. /f�
Owner's Name and Address. 29 " /°'1 .Rd --7/1 No... .1. 3 Street
Registered Architect and /or Engineer .....IS.iP��
Employing Electrician's Name...E.) / " . . ,..:eiV ... 111 4 - 41 !'f. 3 Street
Subdivisio
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
Location and Legal Description Lot
Amount of Permit $
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date 4 9 — `
Block
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation -- Conduit Tubing B.X.L Metal Moulding
(Signed) PI .DCZK)0
(Signed)
Master Electrician.
jgrie 33e /a
Electrical 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 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 sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. f 's
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.
Permit No ` q g
Registered Architect and /or Engineer
APPLICATION FOR ELECTRICAL PERMIT
Employing Electrician's Name...OPtv9 / 2 n tE e_T"I
Location and Legal Description Lot o� Block
Street and Number where work is to be performed —No / G a Nr 5,7
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
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.
ir Owner's Name and Address C No 3 Street
No // `S it Street /
Street
Subdivision
/ Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L .Metal Moulding
Amount of Permit $
(Signed)
ectrical Ins . actor.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi ations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-con ctors 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 under this permit, as are
licensed by Miami Shores Village.
(Signed)
aster Electrician.
STATE OP FLORIDA, 1
COUNTY OP DADE. j 0e '
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 facto
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
0
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
H
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/
CHECK
Permit No ` q g
Registered Architect and /or Engineer
APPLICATION FOR ELECTRICAL PERMIT
Employing Electrician's Name...OPtv9 / 2 n tE e_T"I
Location and Legal Description Lot o� Block
Street and Number where work is to be performed —No / G a Nr 5,7
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
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.
ir Owner's Name and Address C No 3 Street
No // `S it Street /
Street
Subdivision
/ Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L .Metal Moulding
Amount of Permit $
(Signed)
ectrical Ins . actor.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obi ations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida ermanent Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-con ctors 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 under this permit, as are
licensed by Miami Shores Village.
(Signed)
aster Electrician.
STATE OP FLORIDA, 1
COUNTY OP DADE. j 0e '
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 facto
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.
z ° MIAMI SHORES VILLAGE
O ELECTRICAL INSPECTION DEPARTMENT
(' ' APPLICATION FOR ELECTRICAL PERMIT
Permit No Date Z 1 - 7 e.
1I
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, 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...
Registered Architect and /or Engineer...
Employing Electrician's Name 414* R No 4' 41/, 5. 1 0 Street '.
Location and Legal Description Lot 1 -y Block Subdivision
Street and Number where work is to be performed —No � i� ....... .f /....� Street 7 4 "
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs No. of Stories
New Building
Amount of Permit S
� Ce Overhead Site Feeders i° Conduit Main Sw Amps. 00 Main Fuses. a Amps
Underground
Type of Installation — Conduit 4 """ .. Tubing B.X.L .Metal Moulding
ectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl�i�g tions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida )i''ermanent 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 subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, 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.
ss.
My Commission Expires Notary Public, State of Florida
NOTE: A re inspection fee of $1.00 will be made when such re•inapection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
C7
(Signed)
(Signed)
No Street
Muter Electrician.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
ReCE'P'T'e
FIXTURES
NO. LAMPS
REPRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H
W. HEAT.
CONN.
SPACE
H
STRIP
H
TOTAL
% LIST
/O
/I
.3C
2
I
1
2-7
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1•5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/ ZO
s
CHECK
z ° MIAMI SHORES VILLAGE
O ELECTRICAL INSPECTION DEPARTMENT
(' ' APPLICATION FOR ELECTRICAL PERMIT
Permit No Date Z 1 - 7 e.
1I
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, 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...
Registered Architect and /or Engineer...
Employing Electrician's Name 414* R No 4' 41/, 5. 1 0 Street '.
Location and Legal Description Lot 1 -y Block Subdivision
Street and Number where work is to be performed —No � i� ....... .f /....� Street 7 4 "
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs No. of Stories
New Building
Amount of Permit S
� Ce Overhead Site Feeders i° Conduit Main Sw Amps. 00 Main Fuses. a Amps
Underground
Type of Installation — Conduit 4 """ .. Tubing B.X.L .Metal Moulding
ectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obl�i�g tions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida )i''ermanent 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 subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, 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.
ss.
My Commission Expires Notary Public, State of Florida
NOTE: A re inspection fee of $1.00 will be made when such re•inapection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
C7
(Signed)
(Signed)
No Street
Muter Electrician.
Date ie • //• 9: Job Address AA 31-
N � 93 .5 77 Tax Folio II fade /4 19 f l 1
Legal Description q�
/ Lessee / Tenant ..1 / e 41.4-7 - 7-1 4
Owner's Address /O 9S` _rr
Contracting Co.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
.27 8'4 - 77) s .1 r/
° 0Z-41 /G i L:
T kid0 - ss #t -
�
Qualifier �.J � (J
State # E-c6//99 ' Municipal # Competency # CZ. JG6 o Z
Master Permit # -CS /® °2'
Phone 7,57 - O.S
Address (p 6 q #' CA) 9D 5r
89/ —/37
Ins . Co . f - 1. /Jce--r
Phone
Architect /Engineer AJ/ Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Cc. 2e 0.02) , leD L lUiu 2 7-<4'T (),'j T66 - 7 3 -
460.c.4D iS rzi GJ 4 CA 217.) 4 , -i 4' iC
Square Ft. Estimated Cost(value) 3d
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 - d. i
A
Si 'Iature of owner and /or Condo President
Date :
e hrt
r
Notary as t _ ..Owner and /or Condo4sident
My Coi nis riP PE4.$� OF FLORIDA
MY COMMISSION EXP. JAN.31,1994
BONDED THRU GENERAL INS. UND.
** * * * * *
Signature of Contractor or
Date:
er- Builder
Notary a to Contractor or Owner Builder
My Commission Expires:
liStiin PUBLIC STATE OF FLORIDA
PTi( MISSION EXP. IAN. 311, 1994
* * * * * l MED TA'RU GENEIPAL INS.'
* *
FEES: PERMIT 0 RADON C.C.P. ►-'l.(° NOTARY TOTAL DUE !/ v 5-
APPROVED: Fire Other
Zoning Building Electrical
Mechanical Plumbing_
Engineering