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1080 NE 96 St (8)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 the work. Owner's Name and Address Registered Architect and/or Engineer ►cDF Name and address of licensed contractor Location and legal description of lot to be? on: Q Lot 4 Block SubdivisionfC-./ /A FC N Street and Number where work is to be done State work to be done and purpose of building (by floors), state exterior colors (submit samples) Lnl STATE OF FLORIDA COUNTY OF DADE. tOr • NC. ;0 1 o d t Nom. fS S / AWIT New Building Remodeling } SS. o� V es (� MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT /v\ R 1.< NCH yA A UST Vg Addition rx...,e Remarks (Signed) K P�� - `/ ) t7A ICS l ic e r 'd o 1 Amount of Permit $ I G Date No. / ®C7 f/ &re:0 w, IA 41 3 // £2 * v`5 9 6 J. Repairs No of Stories // / / 19 ?1 and for no other purpose. To be constructed of Kind of foundation Roof Covering e stimated Total cost of improvements S C O Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all 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 obligatons 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 agree employ, only such subco tractors. on work to be performed under this permit, as are licensed by Miami Shores Village. 7 I mo \ tit 6 Before me. the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Date /1//7 /err Read, Sworn to and Subscribed before me. Permit No Disapproved - Date i \ Notary Public, State of Florida (Signed) to me well known. Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved ()ate Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. 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 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 the work. Owner's Name and Address iv\ IZ (< I f 2C I-(E R — Registered Architect and /or Engineer �A ST ROOF IA/ I 3 ©3 © SW ? ,4t/e Name and address of licensed contractor Locatio and legal description of lot to be ilt on: 3 �/ j� Lot V "1 Block Subdivision 7/14 f �/ J /1 lA I / / // 3� .0e / Street and Number where work is to be done 0 c7 N CL (s) ,5-+ State work to be done and purpose of building (by floors), state exterior colors (submit samples) R P (e*z. t;-•-• 13 cv ve ( 6 Roof — -t il wov lu eR � New Building Remodeling Addition Repairs 'lb be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements S 3 Amount of Permit $ 30. d e Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to g hwc 30 Sw 3,P acre The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida. Permanent Supplement, and has complied with the provisions thereof. and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors. on work to be performed under this permit. as are licensed by Miami Shores Village. ce � U sr_ 2—& '7 rs Remarks (Signed) Date 8- 1 19 No. 10 0 Street A) F ( 1(0 St 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. that he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. ..?9 Date Date 9 Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Notary Public, State of Florida e ae O /to (o/9 and for no other purpose. No. of Stories 2__ /f Pc &6e / l! 6 e Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-inspection fee of $25.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. Lot 4 SHORES VILLAGE BUILDIN INSPECTION DEPARTMENT AF LICATICI N FOR nUILDING PERMIT Application is hereby made for the approval of the det,iled statemen• of the plans and specifict.inns herewith submitted fo, the build- ing or o h. - ructure her 1 described This i-t licatc is made in compliance and con o'm ty w.th the Building Ordinance of Mia ri Shores Villaee, or da, and all pro isions of the Laws tf the State cf Florid. all o d nances of Mi nu Shores Village- and all rules and regu a ion of the Building Div . i of .ram Shoi illage r '1 ,e -0. ipl.ed with, whether herein specified or not. A copy of approved plans and specificati •n must be kei • at bui:dmg durin progress of tl.e wcrk. Date AUF i1 `(Ia , 19 t' ( 2: Owner' Name and Address D W© PO AR 028 No. 7 ©tM Street_ P.D. t.n ',7 u, 3 _ Registered Architect and /or Engineer nd address of licensed contractor SL /\ . i°:�,ii.P7OGr c$E3 l _ - T :`�`_�`Al1JC RICS,_ ie. ?6:1 e� ° c0 . __ iI`i°' Location and legal description of lot to be built on: Block__ ___ Subdivision Street and Number where work is to be done. 2S0e' 640 a _ f s th tToot State work to be done and purpose of building (by floors) Lc_di=U.__ta_sa.Ez 1.541 Zola _o__zzw10 -- __GravQ2. — — and for no other purpose. New Building _ _ Remodeling._ _.__ _ ._. Addition__ _. - -_._. __ _ Repairs_ _ _ No. of Stories To be constructed of _ Kind of foundation Roof Cov ' ,tal cost of improvements $._ 7.L ( 3.43 _ Amount of Permit $__ . Zone ^ubage required- __. __Plan Cubage Distance to next nearest building__ _ _ _ Size of Building Lot °Taxfmum live load to be borne by each floor _ . hereby submit all the plans and specirications for said building. All notices with reference to the building and its construction may be sent to __.- . __ The unde signed appli ant for th - s bulding permit does hereby certify t'iat he understands and accepts Ms .•bligations as an employer of 1 bor under he Florida Workmen's Compensation Act being S. -tion 5966 Col p led Gen al Laws of Florida P r anen Sapplt Went, and h s compl ed with he prov' cons thereof, and will require s•niilar comp lance from all contractors or subcontractors emplo 'ed by him in the wo k to be p rf med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public note e or .otices as are requir d l-y the Act. The u. d. r ign .d agrees to employ only such abcontr. ctors, on work to be perform d der this permit as are licensed by M am. Shores \ il.: ge. 5g� nn/I i�; Pyc B� :S'� D. h il c! a y � �� u - 1 ;1' I�IUi U '.' JD ,,..,_,30 Remarks (Signed) i / -� STATE OF FLORIDA, 3� O ° ` . J COUNTY OF DADE. ' ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths ,,nd take acknowledgments, personally ap- pcared Notary Public State of Florida to me well known, and who, being by me first d. ly sworn, upon oath depo , •es and says that he is the of th abov de c ibed .struction t. h has careially read the foregoing application, and that he did sign the same, and that all facts therein by him stated are tr ie. Permit No Date__ __.. Read, Sworn to and Subscribed before me. Disapproved _.__ Date. (Signed) Building Inspector My Com:nission Expires. PLANNING BOARD .._.DATE Chairman Member _ ....._ _ Member _ --- -- _ 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 Ifter approval h is been obtained from the I'lanr ng Board A re- inspection fee of $1.00 will be charged when such re- inspection is m. .e necessary by improper notice h-r inspe:-t• rs or fa. Ity materials and /or workmanship. BUILDING ❑ DATE 195 ELECTRICAL ❑ PERMIT N° 14773 PLUMBING ❑ ROOFING [Q Work to be performed under this Permit Owner of Building Architect Contractor or Builder Legal Lot II BI. Description, Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Subdi- vision Value of Project $ Contractor's License No. Amt. of Permit $ 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, servant or employee. BY AUTHORITY efea_ APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept a' building during progress of the work. Owner's Name and Address Name and address of licensed contractor T , Registered Architect and /or Engineer Location and legal description of lot to be built on: Lot Block Subdivision Street and Number where work is to be done l State work to be done and purpose of building (by floors) C� . MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT Date /l° , 19 () No /C c < Street G , f �''... /a (a 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 $ Amount of Permit $ Zone cubage required plan Cubage Distance to next nearest building._... Size of Building Lot Maximum live 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 labor under the Florida Workmen's Compensation Act, being Section 5966, 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 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 subcontr ctors, on to bgfperformed under this permit, as are licensed by Miami Shores Village. Remarks _________ . (Signed) to me well known, STATE OF FLORIDA, COUNTY OF DADE. ss Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared __ and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit Date Read, Sworn to and Subscribed before me. Disapproved _ Date Notary Public, State of Florida (Signed) Building Inspector. My Commission Expires PLANNING BOARD DATE Chairman Member Member 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 from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. APPUCATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Location and legal description of lot to be built on: Chairman Member Member Council Approved Date NOTE: A charge of $1.00 will be made for the Planning Board. A re- inspection fee of $1.00 will be charged materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING INSPECT :ON DEPARTMENT Date c p,o Owner's Name and Address ' fre e1'lrcl!®0 �( �� s^ C' i r; e.. No Street <1 Registered Architect and /or Engineer Name and address of licensed contractor 1e?Y __aC ._ 6__1 LC __ _ '.?fs Tg.o 21 .P,.`5 @treat Lot Block Subdivision Street and Number where work is to be done W_1_.____z.` State work to be done and purpose of building (by floors) 1 7 \i© Vidr) n __ C _ fJ € oi__/:__ * `, _! t =;s' o{ 2 oto!_y 7;,0x" D ©p in 1 - 3* fo1b to oniGtinz_ ro ' , 0 -- 1.®Fx;. 5 . `.o:i o GU'en taiO and for no other purpose. New Building Remodeling Addition Repairs 2 No. of Stories To be constructed of Kind of foundation Roof Covering F� Estimated Total cost of improvements $ �a�e�� Amount of Permit $ •�" Zone cubage required _Plan Cubage Distance to next nearest building Size of Building Lot Maximum live 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 2 31, D.1 VS 0tyo 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 wo such public notice or notices as are required by the Act. The undersigned agrees to employ only such /subcontractors, on work to' be erformed under this permit, as are licensed by Miami Shores Village. - -- Remarks__-- (Signed) -__ - -- / v Notary Public, State of Florida PLANNING BOARD DATE STATE OF FLORIDA, ss. COUNTY OF DADE. J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared -- — 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. . • �, — . Permit No _ 1�___/___ J > Date �' Read, Sworn to and Subscribed before me. Disapproved Date (Signed) — ,, —.` ,- Building Inspector My Commission Expires Member Member Member Disapproved Date making corrections or changes to this application after approval has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building ( , Architect Contractor or Builder Legal Description Lot Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA ti, DATE PERMIT Bl N° 7386 Work to be performed under this Permit Contractor's ' License No. Value of •--' l! Amount of Project $ 1 1 Permit $ 196L 1� : 4 Subdi- vision s. In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance wifb 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 ac• cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Signed _ INSPECTOR 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 applica- tion 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 respon- sibility for work done by his agents, servants or employees. BY AUTHORITY +Ivor "'y`' Applicat on is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing o. other stru ture he ein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Vilag F orida, and all previsions of the Laws of the State of Florida, all ord'nances of Miami Shores Village and all rules and regulations of the Building Division of Miam Shores Village sh 11 be con plied with whether her in specified cr not. A cop of approv d piens and specifications must be kept at budding during progress of the work. Date_Ma rah __ 1966 _ 19 _ Owner s Name and Address ___ W_0 F 0 An d e s_ . 10 80 N. E. 96th _S No__ _____ __ _ ___ Street__ Registered Architect and /or Engineer - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - N a m e and address of licensed contractor __PALMER' S ROOFING CO. 9 INC o 1729 No. Miami Ave. Location -nd legal description of 11t to be built on: Lot_ -- _ Block -- - _ _ -- Subdivision_ - - -- -- _ __ -- Street and Number where work is to be done_ 10 8 Q. N_. - E 0 _9 6th Street _ . ___ __ State work to be done and purpose of building (by floors)___ Re-Roofing 4 -Ply Aspahlt and Aluminum Coating. 4 Squares. For the sum of ....... 0 . $2 - 87:00 - -- --- -- 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 $ ___ _ _. _ Amount o` Permit $ Zone cubage required_ _ plan Cubage Distance to next nearest building_ _. _ __ . __ __ __ _ _ _ __ ______ _____ _ __ _ _Size of Building Lot____ _ _ Maximum live load to be bcrne 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 h- understands and accepts his ob _ . '.ns as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of : i.a, Perm ent Supplement, and has complied with the prnvisions thereof, and will require similar compliance from all contractors sub - contracto employed by him in the work to be performed u der this permit; and will post or cause to be posted for inspection o '1 e site of the , .rk such public notice or notices as are required by the Act. The undersigned agrees to employ only :k o :p }peformed under this permit, as are licensed by Miai. ' Sho es Village. / / // Remarks-- -- - (Sign STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly •.uthorized to administer oaths and take acknowledgments, personally ap- peared -- - and who, being by m: fist duly swo:r, upon oath deposes and says that he is the __ . _ _ _ _ . - ___ _ _ of he above described construction thai he has carefully read the oregoingc7o!ication, and that he did sign the same, and that all facts therein b-: him stated are . e 3 Per it No. _ _ Disapp °o ed (Signed) Chairman Member Member _ _ Coin iI Approved MDAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR EUILOENG PERMIT Date_ Read, Sworn to and Subscribed before me. Date - - - - -- - -- -- - -- -- -- -- -- - Notary Public, State of Florida My Commission Expires __ _ Building Inspector PLANN IL►� BOARD DATE __ to me well known, Member Member _ _ M ben Date D :approved _ _ Date NOTE: A charge of $1 00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board A re- iu_pec: 61 fec of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address Registered Architect and /or Engineer �? Name and address of licensed contractor —✓"l- , 1-.fQ 7 Location and legal description of lot to be built on: Lot. Block Subdivision Street and Number where work is to be done /° 6 ° N _ State work to be done and purpose of building (by floors) New Building Remodeling Chainnan Member Member - - Council Approved MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Date__ PL NING BOARD__ __ NOTE: A charge of $1.00 will be made for making corrections the Planning Board. A re- inspection fee of 51.00 will be charged materials and /or workmanship. No Street e Date Addition Repairs No. of Stories 19 Si and for no other purpose. To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements $ �� o Amount of Permit $ Zone cubage required _._ _ . _ .Plan Cubage__ __- Distance to next nearest building__ - Size of Building Lot Maximum live 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 labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contract s or sub - contractors employ d by him in the work to be performed under this permit; and will post or cause to be posted for inspection o. the 'te of the work such tf blic notice or notices as are required by the Act. The undersigned agrees to employ only such sub .ntractos, on r4 k to be perffj ., under this permit, as are licensed by Miami Shores Village. - Remarks_. _ ( Signed ) __ STATE OF FLORIDA, COUNTY OF DADE. j ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared . 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. / 7 Date 3 -1 - 2_-C-7 - Read, Sworn to and Subscribed before me. Permit No._ Disapproved (Signed) (s! j Building Inspector,Y My Commission Expires Notary Public, State of Florida DATE Member Member Member _Date Disapproved or changes to this application after approval Date has been obtained from when such re- inspection is made necessary by improper notice for inspection or faulty