ELECTRICALPermit No
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL (PERMIT
Date /o / ° 717
Application is hereby made for the approval of the detailed statement of the plans and specification; 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 (€ Ca_... V 4/ e l/
Registered Architect and /or Engi
Employing Electrician's Name ' S
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building
STATE OF FLORIDA, 1
COUNTY OF DADE. I
59.
MIAMI SHORES VILLAGE
ec
e G.:.I _ C
G 0, No. /, Street 14../ dkor
Block r r Subdivision
l.�.a. Street
State work to be performed and purpose of building (By Floors)
Remodeling Addition
Repairs No. of Stories
Service Underground Size Feeders / Conduit / a.....Main Sw C: "?, s. Amps.. / r e Main Fuses .Amps
Type of Installation— Conduit Tubing B.X.L Metal Moulding;
Amount of Permit $ (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his 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 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.
(Signed)...
No 3.. `S Street / ..7... V Jr
I►t.•s •r ,V / T/ 4
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
TE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
may(rials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
H
STRIP
HEATER
TOTAL
C
LIST
IST L
/ a
/ L
I
al 3
17
• ZO
/
/
0
/
/
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
O.1 HP
MOTORS
1.0 HP
N EON
'MANS.
RADIO
TOTAL,
CONTR.
UST
7
/
CHECK
/ t141
/
Permit No
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL (PERMIT
Date /o / ° 717
Application is hereby made for the approval of the detailed statement of the plans and specification; 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 (€ Ca_... V 4/ e l/
Registered Architect and /or Engi
Employing Electrician's Name ' S
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building
STATE OF FLORIDA, 1
COUNTY OF DADE. I
59.
MIAMI SHORES VILLAGE
ec
e G.:.I _ C
G 0, No. /, Street 14../ dkor
Block r r Subdivision
l.�.a. Street
State work to be performed and purpose of building (By Floors)
Remodeling Addition
Repairs No. of Stories
Service Underground Size Feeders / Conduit / a.....Main Sw C: "?, s. Amps.. / r e Main Fuses .Amps
Type of Installation— Conduit Tubing B.X.L Metal Moulding;
Amount of Permit $ (Signed)
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his 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 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.
(Signed)...
No 3.. `S Street / ..7... V Jr
I►t.•s •r ,V / T/ 4
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
TE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
may(rials and /or workmanship.
Permit No
STATE OP FLORIDA, }
COUNTY OF DADE
s8.
r`) MIAMI SHORES VILLAGE
J 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 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 complie ith, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work
��;' t..
Owner's Name and Address .... No.. Street 4 x .... / .. -
Registered Architect and /or Engineer
Employing Electrician's Name... k..
, ............, No Street ,.
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No i ,< l S:reet , / y .
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition 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 $ (....,,.....r— (Signed)
E1e rical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations '3s 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 o: 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 Kfrirmed under this permit, as are
licensed by Miami Shores Village. ,
My Commission Expires
d /
(Signed) .( '
1
Notary Public, State of Florida
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.
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
HEATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
°'..
Li -.
�,..
CHECK
'
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
P EON
TRANS.
RADIO
TOTAL
CONTR.
LIsr
CHECK
Permit No
STATE OP FLORIDA, }
COUNTY OF DADE
s8.
r`) MIAMI SHORES VILLAGE
J 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 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 complie ith, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work
��;' t..
Owner's Name and Address .... No.. Street 4 x .... / .. -
Registered Architect and /or Engineer
Employing Electrician's Name... k..
, ............, No Street ,.
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No i ,< l S:reet , / y .
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition 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 $ (....,,.....r— (Signed)
E1e rical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations '3s 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 o: 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 Kfrirmed under this permit, as are
licensed by Miami Shores Village. ,
My Commission Expires
d /
(Signed) .( '
1
Notary Public, State of Florida
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.
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.
MIAMI SHORES VILLAGE, FLDIRIDA
BUILDING ❑ DA
ELECTRICAL PERMIT SIT? 12583
PL ❑
ROOFING El Work to he d under this P
&•••—•
Owner of
Building _ ,
Architect
Contractor
or Builder
Legal
Description
Address of
Building
This permit is granted to t contractor or budder nomad above to
herefor in strict compliance with all ordinances pertaining thereto and
drawings, statements or specifications that may have been submitted to
time 0 the work is not done in compliance with such ordinances or if the
granted is the understanding that the contractor or build .
p
rie
ertaining to the work covered hereby whethr, .aho h n o e oY
done by his agents, servants or employee
/r
In consideration of the issuance to
pertaining thereto and in strip, conformity with
In accepting this permit I assume responsibility for all
Cis
License
this permit I agree
Subdi-
vision
Value of
INSPECTOR
erform the work covered hereunder in compliance with all
wings I • or ecifications submitted to the proper authorities of Masai
y either, my my agent, sent or employee.
) 1/41
Amt. of
Permit $
or to install the e or devise deseed+ed in t�s
g that the work will be performed to com ace wl ,
without u� a t on.Affurther amdi io ay 1
wr'h3t ie
naibs'iity for a thorough kno of
eta •is or cep
BUILDING ❑
ELECTRICAL DA'�F .� 19
ELECTRICAL
❑ PERMIT N? g 3 g 2 Contractor's
PLUMBING
License No. a 2 1 1
ROOFING ❑
El Work to be performed under this Permit
Owner of
Building 1
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE. FLC)RIDA
4
Bl.
,? 4 1 t i t S #.
CONTRACTOR OR BUILDER
Signed:
Subdi-
vision
Sq. Ft
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 responsibili 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 state is or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
BY
e.., , •
Amt. of
Permit
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereund ; compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submi d to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant' or employee.
AUTHORITY
17
q
M ate work to be performed and purpose of building (By Floors)
� /� 1 New Building �� Remodeling Addition Repairs No. of Stories
1p
APPLICATION FOR ELECTRICAL PERMIT
Permit No j .... to
Application is hereby made for a approval of the detailed statement of the plans and specificati with 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 Electrician's Name_. � .acti.i « - 4 o.. No
Location and Legal Description Lot Block Subdivision Irk
Stree se
Street and Number where work is to be performed —No
NOTE:
materials
MIAMI SHORES VILLAGE
ELECTR ICAL INSPECTION DEPARTMENT
.e_47•10KVittl
No ic.2.,,r7
Overhead Size Feeders .. / ......Conduit .., /! /r Main Sw.... I" 49 Amps
Service loch g ____1
Type of Installation— Conduit Tubing B.X.L Metal Mou
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
12 s
The undersigned applicant for this building permit does here
labor under the Florida Workmen's Compensation Act, being Sectio
has complied with the provisions thereof, and will require similar comp
work to be performed under this permit; and will post or cause to be posted for
as are required by the Act. The undersigned agrees to employ only such sub - contractors,
licensed by Miami Shores Village.
85.
certify that he
966, Com
StreetAe . ;?'' A+
772-- Street,4V r
e '
(Signed)
Main Fuses - Amps
Ele cal Inspector
understands anc! accepts his obligations as an empl
ed General Laws of Florida Permanent Suppleme
om all contractors or subcontractors employed by hi
inspection on the site of the work such public notice or notices
on work to be performed under this permit, as are
er of
t, and
in the
7?„,
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
re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
/or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
P'T'S
RECE'
FIXTURES
NO. LAMPS
REPRICE
OUTLET
IRON
OUTLET
RANG
OUTLET
RANG[
CONN.
WATER
H
W. HEAT.
CONN.
SPACE
H
STRIP
HEATER
TOTAL
el t5NTR
3T
l if
!
/
1 °O
�1
so
41
?
s
s0
ENT.
SW.
D T.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.3 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
I
/
CHECK
�
� f`�
/1)O
q
M ate work to be performed and purpose of building (By Floors)
� /� 1 New Building �� Remodeling Addition Repairs No. of Stories
1p
APPLICATION FOR ELECTRICAL PERMIT
Permit No j .... to
Application is hereby made for a approval of the detailed statement of the plans and specificati with 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 Electrician's Name_. � .acti.i « - 4 o.. No
Location and Legal Description Lot Block Subdivision Irk
Stree se
Street and Number where work is to be performed —No
NOTE:
materials
MIAMI SHORES VILLAGE
ELECTR ICAL INSPECTION DEPARTMENT
.e_47•10KVittl
No ic.2.,,r7
Overhead Size Feeders .. / ......Conduit .., /! /r Main Sw.... I" 49 Amps
Service loch g ____1
Type of Installation— Conduit Tubing B.X.L Metal Mou
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE.
12 s
The undersigned applicant for this building permit does here
labor under the Florida Workmen's Compensation Act, being Sectio
has complied with the provisions thereof, and will require similar comp
work to be performed under this permit; and will post or cause to be posted for
as are required by the Act. The undersigned agrees to employ only such sub - contractors,
licensed by Miami Shores Village.
85.
certify that he
966, Com
StreetAe . ;?'' A+
772-- Street,4V r
e '
(Signed)
Main Fuses - Amps
Ele cal Inspector
understands anc! accepts his obligations as an empl
ed General Laws of Florida Permanent Suppleme
om all contractors or subcontractors employed by hi
inspection on the site of the work such public notice or notices
on work to be performed under this permit, as are
er of
t, and
in the
7?„,
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
re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
/or workmanship.
Owner's Name and Address
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No Z
]Date. A `•
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Registered Architect and /or Engineer
Employing Electrician's Name.... f .CJ ' No 9 $ f .7 Street !4
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
*.-1"
No / �
Street .. /
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)
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 Dr 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 ID be..performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, ,)
COUNTY OF DADE. T
65.
C1s
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 ;ae 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
OUTLETS
LIGHT
OUTLETS
PLUO
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
S{ACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
' V EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Owner's Name and Address
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No Z
]Date. A `•
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Registered Architect and /or Engineer
Employing Electrician's Name.... f .CJ ' No 9 $ f .7 Street !4
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
*.-1"
No / �
Street .. /
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)
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 Dr 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 ID be..performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, ,)
COUNTY OF DADE. T
65.
C1s
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 ;ae 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.