736 NE 94 St (6)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date [ 627- 0, 22. Time
Type Insp'nZ; /1
Permit No.
Name )1// 4 +.S.e
Address lib /VG %T
Company���
Phone # 3 or lO %r� - � c 3 f
For Inspector: C . k_" 7 Name & Date
Approved
Coffee
Re- Insp'n Fee
P-4 cry
7 Pr
D LA. C✓,?
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Daie 'C , Time
Type Insp'n
Permit No. ` P 2602 - /.09
Name (�
Address l , 3 C
Company 7)
Phone # —3 Or & 94-203/
dr—
Correction
Re Insp'n Fee
For Inspector: 6-,21-02 Name &
Type Insp'n
Permit No.
Name
Address
Company
Phone #
- MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date � // �� Time
f Lcc2 -/
73 4 y 7'/
3t f - 2( 3/
For Inspector: 6 _ 2.0 2 Name &
Approve
Re- Insp'n Fee ❑
ge
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date' 0 0 !, i C Ti
Type Insp'n
Permit
Nam 3I L
Address n / (7?, Et • q) J
Company
Phone #
For Inspector
Approved
Correction
Re- Insp'n Fee
61 R /
/ Opt Name to
r ZL.,
adz
er--AE0- G 1T)
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 71 Time
Type Insp'n
Permit No. P 2 2 ° /; "G°
Name �•�/�V
Address / � 4./g 9/
Company �/ e
Phone # e3 f' - 1�
For Inspector: 7..-/-4i,2) Nam
Approved
4
Correction ❑
Re- Insp'n Fee 1771
CONTRACTOR
Name 1 t . :). 6 ,p c ^ n
License No. I �
Address `o 0 �
PROPERTY OWNER
Name % 41 -( &11U trl
Address
`73(o 94 4.- .
Home Telephone
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction Enclosure
Alteration Exterior ✓ Repair
Alteration Interior Demolish
Relocation of Structure Shell Only
Foundation Only Add'I Attachment
Other Add'l Detachment
Other
Step 1.
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. P- c 00 1 OQ-LP
CTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLI
Job Address: - 13(41 S4.
Address
Folio Number //__ Description of Work f i4 y L " re
Lot Block L.0
Subdivisions• Sec, � ' � PB 0 PG 37 x`11
. ( Zoning
Current Use of Property 2 - S t Gl en cie_ tm a Feet Units Floors
/
Proposed Use of Property Value of Work ! / 6 10 , Bldg Value
Tenant Information
PERMIT TYPE ( ✓
Buildin
Electrical
Mechanical
Plumbin
LPGX
Roofing
Fence
Other
ARCHITECT
Name
License No.
Address
Telephone
Fax
ATION
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
lA. slior e s F1
City State
Tax Assessed/Appraised Value
Linear Feet
OCR'
Zip
Flood Zone Base Floor Elev.
ENGINEER
License No.
Name
Address
Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction Enclosure
Alteration Exterior ✓ Repair
Alteration Interior Demolish
Relocation of Structure Shell Only
Foundation Only Add'I Attachment
Other Add'l Detachment
Other
Step 1.
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. P- c 00 1 OQ-LP
CTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLI
Job Address: - 13(41 S4.
Address
Folio Number //__ Description of Work f i4 y L " re
Lot Block L.0
Subdivisions• Sec, � ' � PB 0 PG 37 x`11
. ( Zoning
Current Use of Property 2 - S t Gl en cie_ tm a Feet Units Floors
/
Proposed Use of Property Value of Work ! / 6 10 , Bldg Value
Tenant Information
PERMIT TYPE ( ✓
Buildin
Electrical
Mechanical
Plumbin
LPGX
Roofing
Fence
Other
ARCHITECT
Name
License No.
Address
Telephone
Fax
ATION
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
lA. slior e s F1
City State
Tax Assessed/Appraised Value
Linear Feet
OCR'
Zip
Flood Zone Base Floor Elev.
ENGINEER
License No.
Name
Address
Telephone
Fax
Step 1.
PERMIT APPLICATION
Master Permit No.
Subsidiary Permit No. P- c 00 1 OQ-LP
CTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLI
Job Address: - 13(41 S4.
Address
Folio Number //__ Description of Work f i4 y L " re
Lot Block L.0
Subdivisions• Sec, � ' � PB 0 PG 37 x`11
. ( Zoning
Current Use of Property 2 - S t Gl en cie_ tm a Feet Units Floors
/
Proposed Use of Property Value of Work ! / 6 10 , Bldg Value
Tenant Information
PERMIT TYPE ( ✓
Buildin
Electrical
Mechanical
Plumbin
LPGX
Roofing
Fence
Other
ARCHITECT
Name
License No.
Address
Telephone
Fax
ATION
Apt.
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
lA. slior e s F1
City State
Tax Assessed/Appraised Value
Linear Feet
OCR'
Zip
Flood Zone Base Floor Elev.
ENGINEER
License No.
Name
Address
Telephone
Fax
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signature of Owner
Print Name
S21118,210 subscribed before me this / 3 day of "t ,
Signature of Notary Public - State of Florida
ANA M. TORRES
My Comm ExP. 6/6/2003
No. CC 843457
11 Personally Known 11 Other I.D.
Personally known OR, Produced denti 'cation
SEAL:
Type of Identification Produced:
S n• T FLORI UNTY OF MIAMI -DADE
Signat e fP.ntractor / Qua ifier
Print Name ,�/�
Sworn to and subscribed before me this / day of /ti4 ^'T1
Zoo Z
Signature of Notary Public - State of Florida
SEAL:
Personally known
PERMIT APPLICATION
ANA M. TORRES
My Comm Exp. 6/6/2003
No. CC 843457
I 1
Personally Known 1 I Other I.D.
.. . .e
dr2TrOir
Type of Identification Produced:
ELE TRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTY.
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Vioktions
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MEC ANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Dram
QTY.
TYPE
Generator
QTY.
TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WaIPJWin. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUM P. ING
eri'm
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Wel
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Sea (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
SECTION
BY
DATE
Ming
�� /s/2-`/
.
l ,.)/_71.-
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
/
Building Official
—MOM
+I
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.) $ ' / Q�
Inspector State Educational Fund $
State DCA (Radon) $
Code Enforcement Fine
Zoning Review
try": N a W
PC
IEWED AND P BY:
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
PERMIT FEES
$ C�
$
(sq.ft. = x/1000
x ¢.60)
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
LI CONTRACTOR REGISTRATION
(On File)
TOTAL $ /1
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
5' -O" MAX
21-0"
/ 211 X 4" Wood Rail
I "X6 "crl "X8"
Wood pickets
Concrete
,
-III ° a II
-III
I=II 1
4" X 4" Wand post
WOOD FENCES
trio shores
5I-0"
J
2915 Fences
Wood Posts
4' -0" High or Less = 6' -0" O.C.
5' -0" High or Less = 5' -0" O.C.
2915.1 Wood fences, so located on a property
that by zoning regulations they cannot be used
as a wall of a building, shall be constructed to
meet the following minimum specifications.
(a) Fences not exceeding 5 feet in
height shall be constructed to meet
the following minimum
requirements: from nominal 4 inch
by 4 inch by 8 feet -0 inch long
posts spaced 5 feet -0 inches on
centers, having a fiber stress of
1200 p.s.i. in bending, and shall be ,
embedded 2 feet -0 inches into a
concrete footing 1 foot -0 inches in
diameter and 3 feet -0 inches deep.
Other components shall be
designed to comply with the
provisions of this Chapter and
Chapter 23.
(b) Fences not exceeding 5 feet and 4
feet in height respectively shall be
constructed as provided in
paragraph 2915.1 (a) herein,
except that the spacing of posts
may be increased to 5 feet -0
inches and 6 feet -0 inches on
centers for these heights.
1 '0"
2'0"
2 ' 0 "
1'0"
2'0"
4-
WOOD FENCE
Section 2328 FBC
6'0" Maximum
2x4 No. 3, So. Pine PT
Wood Rails Attached to Post
With four 10d Nails (min.)
4x4 No. 2 , So. Pine PT
Spaced as follows
Fence height
above grade
6' -0"
-0"11
4' -0"
Post
Spacing
4' -0" O.C.
5' -0" O.C.
6' -0" O.C.
Wood Pickets 5/8" Min Thickness
attached to each rail with
Two 16 Ga. staples 1 -3/4" long
10" Diameter
Concrete filled hole
•
•
l I, ( -- Pl contractor /owner, picked up 2 sets of plans for
(address) / 0E- q4 from the Building and Zoning Department on (date)
Colt-1 6 to have corrections done to plans and/or get County stamps. I
understand that the plans need to be brought back to Miami Shores Building and Zoning to
continue the permitting process.
Signature
• • ••• • • • •••
•• •• • • • •• •• • • •
• • • • • • • •
••• • • • •• • • • • • • • • • • • • • • • •
••• teizc CLIte4 4,ll
• - • • • . ar
• • • • • • BUILDING AND ZONING DEPARTMENT
RECEIPT
10050 N.E. SECOND AVENUE
• • • • •• r1I tM I SNORES, FLORIDA 33138-2382
••• • • ••• * (305) 795-2204
A, (305) 756-8972
• • • • • ••• • •
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6 /17/2002
Applicant:-R1E
Owner: -MASER
JOB ADDRESS: 736
Contractor POPEYES FENCE & CONSTRUCTION CO
Local Phone:
Parcel # 1132060141680
Permit Status:
Work: 5' HIGH WOOD FENCE
Signed;
Fees:
FEE2002 -3401
FEE2002 -3402
..w t Lt U.!
NE 94
•
Description
Building Permit Application Fee
CCF
Total Fees:
(INSPECTOR)
Building Permit
Permit Number: BP2002 -1096
MASER P.)Ce-
ST
Contractor's Address: 10801 NW 27 AVE
Legal Description: 5 -6 53 42 MIAMI SHORES SEC 3
Amount
$60.00
$1.20
$61.20
Approved Permit Expiration: 12/11/2002 Construction Value: $100.00
BY:
Page 1 of 1
B2
PB 10 -37 LOT 11 & E1/2 LOT 12 BLK 65 LOT SIZE
Total Fees: $61.20
Total Receipts: $0.00
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the budding 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, sery fijs or employe
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 responisibility for all work done by either
myself, my agent, servan or employes.
(Contractor or Builder) BY:
R/T 067006432
& •
Ultra Fence Company
17055 NW. 78th Ave.
Hiaaak, Ji 33015
First Union National Bank
ORD OF a e tqc 4voni
PAY
TO THE
rx)
FOR WO fv&
10 qq4011,1111hi 6
00 3 2 3 211° ' 6 70064 3 21: 26 24806 ? 2p 20
DATE 6
$
Z % 0
63-643/670
BRANCH 13093
Village of Miami Shores
Building Department
10050 NE 2 Ave
Miami Shores, FL 33138
RE Fence Permit BP2002 -1096
Timothy Barnum
736 NE 94 Street
Miami Shores, FL 33138
305 -754 -7440
The building inspector requested a letter from our neighbor agreeing to placement of the fence
that goes around a tree on the property line.
Sincerely,
Timothy Barnum
07/01/02
MIAMI SHORES CODE COMPLIANCE
RE: WOODEN FENCE @ 736 NE 94 ST.
MIAMI SHORES, FL 33138
?etrw,A 13Pa0o2 —/09C
To Whom It May Concern:
1, L I / A R ;a do herein agree to placement of
9� �7Ti� �FiY � portion of wooden g p p
fencing which crosses the eastern boundary of my property adjacent to # 736 NE 94 St.
Said portion of fencing is surrounding tree which is on west facing property line of #736.
Property owner:
Mark Thibodeau
Signature:
Date:
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications th sulnaglo the build-
ing or other structure herein desaibed. This application is made in compliance and conformity with the Bu of Miami
Shores Village, Florida,. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores V and all rules and
regulations of the Buikling 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 progreu of the work.
Location and le
Owner's Name and Address. (2) ,
Registered Architect and/or Engineer
Name and address of licensed oontractor_ehagratial:)
Street and Number
State wsk to be done and purpose of building (by noon)
„- /7,4
p4c.k.
Date..
-4
desedptionoflottobebudlon:
Block 41% i2. 2
IC Liz) -
,19
A14-
here work is to be done 7 4, • 905
ai
and for no other purpose
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation Roof Covering
Estimated Total cost of improvements $ .17.10 °e) Amount of Permit $
-Plan Cubage
—Size of Building Lot
Zone cubism required..
Distance to nest nearest building-
Maxhnum Uve load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of tabu under the Florida Workmen s Compensation Act, being Section 5968, Compiled General Laws of Florida, Pennanent 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 perfonned under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notlees as are required by the Act. The undersigned agrees to employ only such subcontractors, on work t-&-/t,C o le perfmned under this
(Signed) /
permit, ae are licensed by Miami Shores Village. c.,; //t
STATE OF FLORIDA, •
COUNTY OF DADE. ”
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
to me well known,
and who, toeing by me first duly sworn, upon oath deposes and says that he is the.
of the above deanibed 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 One.
Permit
Disapproved ---
(Signed)
PLANNING BOARD DATE
Member
Member
Member
Council Approved._ -- Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained fmin
the Planning Board.
A re-Inspati= fee of $1.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials and/or waitmanship.
Chairman —
Member —
Member
Data ........
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
pector My Commission Expires
lV , 94 sr,