1270 NE 94 St (2)Permit No
Amount of Permit $
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted; for the building o: 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 Kettler 127 E. 94th S.t
...r.eet
No Street..Ne..
Registered Architect and /or Engineer
Employing Electrician's Name State—Wide Electric, Inf 20.43 Street N....W.....141 Street
Location and Legal Description Lot Block Subdivision.
Street and Number where work is to be performed —No 1270 Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition t" Repairs No. of Stories
Service Overhead Site
Feeders ...................Conduit Main Sw Amps Main Fuses .
Underground
Type of Installation -- Conduit Tubing... .. B.X.L... Metal Moulding
1,LNL
(Signed)
Electrical Inspector.
The undersigned applicant for this building permit dots hereby certify that he understands and accepts is 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.
Date !' `'�' 7)
N-6- -E. 94th Street
/'-/
Amps
Maste�ian.
STATE OF FLORIDA, }
COUNTY OF DADE. 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'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONK.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CL
LIST
j �1.
J W
T /
n
�• 71
CHECK
•
.* 't�'t,
- ' . 4
Y. OD ,
TOTAL
ENT.
Sw.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
1
MOTORS
0.1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
CONTR.
L IST
CHECK
/�`�''�,',,,',,-`�^,, '
P D d JIlzh; • = l
C
, ?• 5,
ie
Permit No
Amount of Permit $
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted; for the building o: 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 Kettler 127 E. 94th S.t
...r.eet
No Street..Ne..
Registered Architect and /or Engineer
Employing Electrician's Name State—Wide Electric, Inf 20.43 Street N....W.....141 Street
Location and Legal Description Lot Block Subdivision.
Street and Number where work is to be performed —No 1270 Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition t" Repairs No. of Stories
Service Overhead Site
Feeders ...................Conduit Main Sw Amps Main Fuses .
Underground
Type of Installation -- Conduit Tubing... .. B.X.L... Metal Moulding
1,LNL
(Signed)
Electrical Inspector.
The undersigned applicant for this building permit dots hereby certify that he understands and accepts is 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.
Date !' `'�' 7)
N-6- -E. 94th Street
/'-/
Amps
Maste�ian.
STATE OF FLORIDA, }
COUNTY OF DADE. 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.
building during progress of work. /
Owner's Name and Address .....0 .i! "�
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No J...�. 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 complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
Registered Architect and /or En 'neer
� c'
Employing Electrician's Name .Q..: 3`2.. No f} �� Q Street...�/� ��
Location and Legal Description Lot... Block Subdivision 8 i""I �//!..� L'"./
Street and Number where work is to be performed —No J 0 Street ... 1 ..",F7
State work to be performed and purpose of building (By Floors)
V
New Building Remodeling Addition Repairs No. of Stories
Service UOnderground Size Feeders Conduit l Main Sw.'/ Amps
Type of Installation — Conduit Tubing // B.X.L Metal Moulding
Amount of Permit $
'' J Electrical Inspector.
The undersigned applicant f 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.
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
(Signed)
(Signed)...... % .s�,�
Street ...01! ',/
f) Main Fuses
Master Electrician.
V S (�
Amps
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.
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 nd /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
R ECE'P'T'S
FIXTURES
N O. LAMPS
REFRIG.
OUTLET
IRON
O UTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. H EAT.
CONN.
SPACE
H EATER
STRIP
H EATER
TOTAL
22,
CHECK '
i., 92
MO
/ D
J
//
(7 .,�
♦ ..'
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
///�
i
y ,s'
;.
CHECK
A an
/ (./�
, I
building during progress of work. /
Owner's Name and Address .....0 .i! "�
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No J...�. 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 complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
Registered Architect and /or En 'neer
� c'
Employing Electrician's Name .Q..: 3`2.. No f} �� Q Street...�/� ��
Location and Legal Description Lot... Block Subdivision 8 i""I �//!..� L'"./
Street and Number where work is to be performed —No J 0 Street ... 1 ..",F7
State work to be performed and purpose of building (By Floors)
V
New Building Remodeling Addition Repairs No. of Stories
Service UOnderground Size Feeders Conduit l Main Sw.'/ Amps
Type of Installation — Conduit Tubing // B.X.L Metal Moulding
Amount of Permit $
'' J Electrical Inspector.
The undersigned applicant f 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.
STATE OF FLORIDA,
COUNTY OF DADE.
ss.
My Commission Expires
(Signed)
(Signed)...... % .s�,�
Street ...01! ',/
f) Main Fuses
Master Electrician.
V S (�
Amps
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.
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 nd /or workmanship.
4,
Permit No.
Employing Electrician's Name y 1!
Location and Legal Description Lot
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLI�I ; YG C JR ELECTRICAL 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 at
building during progress of work.
Owner's Name and Address.. ../�t ... / ( No Street
l
Registered Architect and /or Engineer'
ss.
a te:. K `
4
No Street
Street and Number where work is to be performed —No...
State work to be performed and purpose of building (By Floors)
New Building (mil Remodeling Addition Repairs
Date `1A2.
a
Block Subdivision. .e F�....1�1....8 .g V
S et....f !
�
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
(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 empl ed 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)
My Commission Expires . 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
OUTL
RANGE
'U
RANGE
WATER
ow-
W. HEAT.
-
SPACE
STRIP
HEATER
TOTAL
•. • . T
CONTR.
LIST
�^
Awili
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM. -'
, t��
/jam
a V
0Y0 s
0.1 P
•RS
HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
'
/
/
MI
CHECK
1
4,
Permit No.
Employing Electrician's Name y 1!
Location and Legal Description Lot
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLI�I ; YG C JR ELECTRICAL 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 at
building during progress of work.
Owner's Name and Address.. ../�t ... / ( No Street
l
Registered Architect and /or Engineer'
ss.
a te:. K `
4
No Street
Street and Number where work is to be performed —No...
State work to be performed and purpose of building (By Floors)
New Building (mil Remodeling Addition Repairs
Date `1A2.
a
Block Subdivision. .e F�....1�1....8 .g V
S et....f !
�
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
(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 empl ed 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)
My Commission Expires . 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.
BUILDING
ELECTRICAL
PLUMBING
• ROOFING
Owner of
Building �
0
Architect
Contractor
or Builder
Legal • Lot
Description.
Address of
Building
❑ Work to be performed under this Permit
CONTCTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
E R M IT 11A. 13412
Bl.
Subdi-
vision
Value of
Project $
B Y
DATE
�. 195
Contractor's
License No
Amt. of
Permit $ ems/
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.
Signed • �� = BY —_,.
INSPECTOR
In consideration of the issuance to me 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 plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume, responsibility, for all work done by either, myself, my agent, servantor employee.
AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description.
Address of
Building
(4)
r 0
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT IT? 13235
n
n W to be performed under this Permit
Subdi-
vision
Value of
Project $
BY
DATE,
Amt. of
Permit
AUTHORrrY
195
Contracto
License No
This permit is gran1red 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 th the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted and approvtrd 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 areh'changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assu es ` he responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawin s in the tatementseor specifications aid that he asginn e / responsibility for work
done by his agents, servants or employees. •
INSPECTOR
In consideration of the issuance to me of this permit agree to pertain the work covered hereunder in com ante with all ordin .'. ces and regulations
pertaining thereto and in strict conformity with the plans, draaifaga, statements or specifications submitted to the proper authorities of amf"Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
Amount of Permit $
STATE OP FLORIDA,
COUNTY OP DADE. I U.
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No 1100 iso Date„ 14k
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, Fiv ;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. p
Owner's Name and Address. / AY` C l Y / No /7- 7 � Street ! L'
v e_ j Ca-2-Popf / 0 77
6;4 /-/ No... T/'°
Registered Architect and/or Engineer
/ E I iy pg cial3 s �lime
Location and Legal Description Lot ! Block
Sf.l 4 "" 1
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs v No. of Stories
Service ` � n • erground Site Feeders /1 .o� 1.1 Conduit. ' Main Sw its — e Amps Main Fuses Amps
Type of Installation-- C.onduit..... /.`.f(.K..'.Tubing.. ... B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands 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 subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
Street
Street : z S
Subdivision S 'i�h
9'/ ST'
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 faeu
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of 21.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OU
LIGHT
OUTLETS
PLUG
RECE'VT's
FIXTURES
NO LAMPS
Sarnia.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
H
TOTAL
CONTR.
LIST
1
✓ �7
CHECK
ENT.
Sw.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
O•t HP
MOTORS
1•8 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
4yr L
Are' A.y"•
CHECK
Amount of Permit $
STATE OP FLORIDA,
COUNTY OP DADE. I U.
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No 1100 iso Date„ 14k
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, Fiv ;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. p
Owner's Name and Address. / AY` C l Y / No /7- 7 � Street ! L'
v e_ j Ca-2-Popf / 0 77
6;4 /-/ No... T/'°
Registered Architect and/or Engineer
/ E I iy pg cial3 s �lime
Location and Legal Description Lot ! Block
Sf.l 4 "" 1
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs v No. of Stories
Service ` � n • erground Site Feeders /1 .o� 1.1 Conduit. ' Main Sw its — e Amps Main Fuses Amps
Type of Installation-- C.onduit..... /.`.f(.K..'.Tubing.. ... B.X.L Metal Moulding
Electrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands 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 subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)
Street
Street : z S
Subdivision S 'i�h
9'/ ST'
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 faeu
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of 21.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.