1091 NE 96 StDate
. Type Insp n
Permit No.
l LC ?S 4 0 1 )
Address /6q / 6 i �/'' •_ S
Company
Phone # ) 96;
a
For Inspector:
V
Approval
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time W
Name & Date
4r
A-)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address ! 09
1 iq E L, STREET Tax Folio // — 3 ZO 6 — L3‘ 0
Legal Description 6w` G 3 Low c31 ( 2 /t B.Z. Historically Designated: Yes No
Owner/L.essee / Tenant BA R 6A-RA- C,o us! AS Master Permit # '/oD 79
Owner's Address I O g I STIR E E
Phone , `j .'_ ✓ <' 7
Contracting Co. A FFO IQD A P, LE STORM PA N E LS Address 4 1 / 4 1 2 ME 1 4 V E rJ UE
Qualifier l/ E 17 Vi . P o /V1 P E R Phone 7'
`
State # Municipal # Competency # - B5OO Z I g Ins. Co. STATE_ FA JM
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / NSTA-L. LATI OF 1Q6MOVi4 $ 1-E S T O(Z/v1 PAA)EL
�
Square Ft. 5.-b Estimated Cost (value) 3 Qd 60
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
c7/0(
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires;.
FEES: PERMIT 4 Vd RADON
)1(
Signature of Contractor or O er Builder
Date
it— 9‘
N'- ary as to Contractor or Owner- Builder
My Commission Expires:
Date
OFFICIAL NOTARY SEAL
JANIE R CHURCH
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC422394
MY COMMISSION EXP. NM. 21,199°
C.C.F. NOTARY 5 TOTAL DUE r l 1#
APPROVED: t r-_ (/
Zonin g Building i If° 1/� Electrical
Mechanical Plumbing Engineering
,
PERMIT NO.
r. STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: /0
/Ll(filr( sows sea 3 Got 3 -Y BKgg ,Mifa7 5/02E s 33/3 e
2. Description of improvement: L ./. Z 14. fr' , f5 j ,i 1 J j , )
3. Owner(s) name and address: 8/97Q / S O (7 &DU /US
Interest in property:
Name and address of fee simple titleholder:
4. Contractors name and address: f vdO.kLJ. .IU rn
44Id, 6)E 11 Hvc. OI'3kvand l f2 3333c/
5. Surety:(Payment tond required by owne from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address: P (j
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to hims0, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
/ Y 1
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of t: ;is Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Notary Public
Print Notary's Name
My Commission Expires:
Signature oI Owner
Print Owners Name . 473 74e/9
TAX FOLIO NO. //- 3006- o/ y- 3660.
96R3177 15 199E JUL 19 09 :57
�f r
eOc(s 0145
Sworn to and subscr,bed before me this Jq day of
q( /VC 96r1
1.
u�...
P CIfi .. 311
At
ri f
r r��
TAT D' 1etNiDA
J za7C4. 7. char t t TY
u c OF DADE
y of the
Gfiiroffi on
4 tr
a %: J I .
d Official Seal,.
Circuit and County aotrrls:
CM.
, 199.4,
Prepared by:
Address: 014 NG / t Avr.
3 N
ffordable 4412 NE 11th Avenue Oakland Park, FL 33334
Steetot Panels
CC# 93- 7163 -AE -X
CC# 94BS00219
July 17, 1996
Building Official
Villiage of Miami Shores
10050 Northeast Second Avenue
Miami Shores, FL 33138
To Whom It May Concern:
We are the Dade County Notice of Acceptance Holder for the 063 Aluminum Panel under
number 94- 0815.01.
This letter authorizes, Keith W. Pomper, Affordable Storm Panels to use our 063 Aluminum
Panel approved under our number 94- 0815.01 to be used at the following job:
Owner: Barbara Cousins
Job Address: 1091 N. E. 96 Street
Miami Shores
Sincerely,
( M auA-ef--7-- g e - nq
Maureen Pomper
President & General Manager
Broward County
Dade County
Phone: 954- 772 -8901 Fax: 954- 772 -7950
305- 795 -2204
305- 756 -8972 FAX
759 -5212
"Quality Products and Professional Service at Affordable Prices"
Proud Member
I r' ?A Cot iMS
_I OGl_i . NE clip STRa —or
6n -L t2 Mom! .SNoRES E
1
OPEOtNIGS
pi+ a
PRODUCT CONTROL NOTICE OIL ACCEPTANCE
Affordable Storm Panels
4412 N.E. 11 Avenue
OaklaIld Pnrlc,
Acceptance No.:94- 0815.01
Expires:12 /13/96
�nnrnvccl: non 7 /) i
FL 33334
Your application for Product Approval of:
Aluminum Storm Panels
under Chapter 3 of the Metropolitan Dade County Codc governing the use of Alternate Materials and
Types of Construction, and completely described in the plans, specifications and calculations as submitted
by:
Applicant, along )vith K,:ezcvich & Associates, Inc. Drawing No. 94 -110, Sheets 1 and 2 of
2, dated 07 /14/94 revised on 08/09/94 and 08/31/94, signed and sealed by V.JKnczevich,
P.E.; American Test Lab. Test Reports No. ATL- 0701.01 -94, ATL- 0701.03 -94 and
ATL - 0701.04 dated 07/20/94, signed and sealed by Gary Elzweig, P.E.
has been recommcnthd for acceptance by the Building Codc Compliance office to be used in Dadc
County, Florida under the specific conditions set forth on pages 2 ct. seq. and the Standard Conditions
on page 3.
This approval shall be valid for a period of three years. The Office of Codc Compliance reserves
the right to secure this product or material at anytime from a jobsitc or manufacturer's plant for quality
control testing. If this product or material fails to perform in the approved manner, the Code Compliance
Department may revoke, modify, or suspend the use of such product or material immediately. The Building
Codc Compliance Department reserves the right to require retesting of this product or material should any
amendments to the South Florida Building Codc be enacted affecting this product or material.
The expense of such t; :sting will be incurred by the manufacturer.
(supersedes No.: 93- 0316.11)
t Dia' . •, P.E.
roduct Control. Division
Supervisor
THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL
CONDITIONS
BUILDING CODE COMMITTEE
This application for Product Approval has been reviewed by the Metropolitan Dade County Building
Codc Compliance Department and approved by the Building Codc Committee to be used in Dade
County, Florida under the conditions set forth above.
METROPOLITAN DADE COUNTY, FLORIDA
METRO -DADE FLAGLER BUILDING
BUILDING CODE COMPLIANCE DEPARTMENT
SUITE 1603
METRO - DADE FLAGLER BUILDING
140 WEST FLAGLER STREET
MIAMI, FLORIDA 331304563
(306) 375-2901
FAX (305) 375 -2900
slr. ger, • ' .
Director
Building Codc Compliance Dept.
Metropolitan Dadc County
APPROVED
EXPIRES Dec. 13, 1996
NOTICE OIL' ACCEPTANCE: SPECIFIC CONDITIONS
I. DESCR TTXON
1.1 This approves an aluminum storm panel designed to comply with the South Florida Building Code
Impact Test Requirement and ASCE 7 -88 "Minimum Design Loads for Buildings and Other
Structures ", for the following location:::
1.1.1 Non - coastal building zone.
1.1.2 Coastal building zone.
2. MATERIAL CHARACTERISTICS
2.1. The storm panels shall be constructed of aluminum alloy 3003 -1 - 114, .063" thick as indicated on
approved drawing No. 94 -110 Sheets 1 and 2.
2.2 Panels have a nominal width of 12.00" and a total width of 13.50 ", forming 1.85" deep ribs.
2.3 Components shall be aluminum alloys 6063 -T6 except the support channel which is 18 gauge
galvanized steel V channel.
2.4 Tested specimen dimensions:
3 panels wide x 114" overall length, (3 panels x 103 1/2" for inside mount)
Width of 3 Panels is 2 at 12.70" and 1 at 12.00 for a total of 37.40 ".
3. LIMITATIONS
3.1 The design ivill be dependent on the maximum panel height of 9' - 6" or 1 14" (8' - 7 1/2" or
103 1/2" for inside mount), to be installed only as outlined on drawing No. 94 -110 Sheets 1 and 2 .
3.2 Minimum separation to existii)Q glass to protect shall be 3.00 ".
3.3 Maximum clearance between top of panel and inside of header shall be 1/4 ".
3.4 Special Requirement:
Support V channels, consisting of 1"x 1.94"x 1.125"x 1.94 "x 1", 18 gauge galvanized steel must be
used vertically at all overlaps. For openings, greater than 57" in height panels, the channel must be
fastened at midspan with one 1/4 "- 20 x 1" machine bolt with die cast aluminum wing nut washer.
4. INSTALLATION
4.1 The panels shall be installed only in thc following condition:
4.1.1 Wall Mount (Direct Mount)
The panels are secured inside a top track ( "1i" header) at the head, which is anchored to the wall; and
fastened to a 2 "x 2 "x .119" continuous studded aluminum angle at the sill, using 1/4 " -20 x 5/8" studs
with washered wingnut spaced at 12" o.c., as shown on detailed drawing No 94 -110, "Wall Mount
Section A" Sheet 2 of 2, bearing the Dade County Product Control approval stamp.
4.1.2 Buildout Mount •
The panels ;tre secured at the head, inside a top track ( "h" header); and at the sill, fastened to a 2" x
2" x .119" continuous studded aluminum angle, using I/4 " -20 x 5/8" studs w/ washered wingnut
spaced at 12" o.c., these sections are secured, using I/4 " - machine screws with nut spaced @12"
o.c., to a milximum 2" x 5" x 1/8" aluminum angle (top & bottom) used to provide thc buildout and
which is anchored to thc wall, as shown on detailed drawing No. 94 -110, "Build -Out Mount"
Section B, Sheet 2 of 2, bearing the -Dade County Product Co trot approval stamp.
SEP12
- il Diamond, P.L.
S upervisor
Product Control Division
2a
APPROVED
SEP 1 2 1994
EXPIR S : Dec. 13, 1996
NOTICE . Or ACCEPTANCE: SPECIFIC CONDITIONS
4.1.3 Ceiling/Inside Mount
The panels are secured inside a top track ( "U" header) at the head, which is anchored to the inside of
opening; and fastened at the sill, using 1/4 " - 20 x 5/8" studs with washered wingnut spaced at 12"
o.c., to a 2" x 2" x .125" continuous studded aluminum angle, as shown on detailed drawing No.
94 - 110, "Ceiling/Inside Mount Section C" Sheet 2 of 2, bearing the Dade County Product Control
approval stamp.
4.1.4 Wall Mount on Wood Framing
The panels are secured inside a top track ( "U" header) at the head which is anchored to the wall and
fastened to a 2" x 2" x .125" continuous studded aluminum angle at the sill, using 1/4 " -20 x 5/8"
studs with washered wingnut spaced at 12" o.c., these sections are anchored to the structural wood
framing with 1/4" SS Lag screws @ 12" o.c. with 1 -1/2" penetration, as shown on detailed drawing
No. 94 -110, "Wall Mount Sections D, E and F" Sheet 2 of 2, bearing the Dade County Product
Control approval stamp.
4.1.5 Any combination of the above.
4.2. Anchorage of the aluminum angles and headers shall be to concrete, masonry and/or wood and shall
consist of the anchors, embedment and spacing specified on Drawing No.94 -1 l0 Sheets 1& 2.
Substitution of anchor type or indicated embedment or penetration is unacceptable and requires to be
engine red separately. Fasteners must have their own Notice of Acceptance.
4.3 Permanent set fastener components, embedded anchor bolts, threaded cones or metal shields, not in
use, must be protected against corrosion, contamination and damage at all time.
5. IDENTIFICATION
5.1 Each nit shall bear a permanent label with the manufacturer's name or logo, city, state and
following statement: "Dade County Product Control Approved ".
Also this following Warning Note shall be permanently mounted vertically behind each overlap
advising the home owner or tenant that "For openings greater than 57" in height, panels and channel
must be fastened at midspan with 1/4 " -20 x 1" machine bolts w/ die cast aluminum washer wino nut
This storm panel system will not offer hurricane protection unless all components are installed as
directed."
6. USE
6.1 Application for building permit shall be accompanied by two copies of the following
6.1.1 This Notice of Acceptance.
6.1.2 Completely dimensioned drawing showing size and location, including height above grade, of
openings to receive shutters; mean roof height, length and width of building.
6.1.3 Duplicate prints of approved drawings No. 94 -110, Sheets 1 and 2 , bearing the approval
stamp, Notice of Acceptance number and date by Dade County Product Control Section,
clearly marked to show the components selected for the proposed installation.
6.2 This revision supersedes Notice of Acceptance No. 93- 0816.11 dated December 13, 1993.
G Diamond, P.E.
pervisor
Product Control Division
AA:VAV.
TEST
TEST LOAD
DESIGN LOAD
Deflection
LARGE MISSILE IMPACT TEST
SFBC PA 201 -94
SATISFACTORY
ATL- 0701.03 -94
•
Max..
2.5"
CYCLIC WIND PRESSURE TEST
SFBC PA 203 -94 POSITIVE
+102.1 PSF
. ATL- 0701.04 -94
+78.5 PSF
ATL- 0701.04 -94
CYCLIC WIND PRESSURE TEST
SFBC PA 203 -94 NEGATIVE
- 102.1 PSF
ATL - 0701.04 -94
-78.5 PSF
A'I'L- 0701.04 -94
UNIFORM STATIC AIR PRESSURE TEST
SFBC PA 202 -94 POSITIVE
+117.1 PSF
ATL - 0701.01 -94
+78.1 PSF
ATL- 0701.01 -94
Max..
2.0"
UNIFORM STATIC AIR PRESSURE TEST
SFBC PA 202 -94 NEGATIVE
-117.1 PSF
ATL- 0701.01 -94
-78.1 PSF
ATL - 0701.01 -94
DESIGN PRESSURE RATING
+78.1 PSF
-78.1 PSF
NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS
7. TESTS PERFORMED
• • IZLS
8. EVIDENCE suBmrrrED
8.1 Tests:
8.1.1 Tcst report on Uniform Static Air Pressure Test of aluminum storm panels, prepared by
American Test Lab, Report No.ATL - 0701.01 -94, dated 07/20/94 ; . signed and sealed by Gary
Elzwcig,
8:1.2 Test report on Large Missile Impact Test of aluminum storm panels, prepared by American
Tcst Lab, Report No.ATL- 0701.03 -94, dated 07/20/94, signed and scaled by Gary Elzweig, P.E.
8.1.3 Test•report on Fatigue Load Test of alutinum storm panels, prepared by American Test Lab,
Report No. ATL - 0701.0' -94, dated 07/20/94, signed and sealed by Gary Elzweig, P.E.
8.2 Drawing:
8.2.1 Drawing No. 94 -110 .063" Aluminum Storm Panel, Sheet 1 and 2 of 2, prepared by
Knezevich & Associates, Inc., dated 07/14/94 revised 08/09/94, signed and sealed by V.J. Knezevich,
P.E.
8.3 Material certification:
8.3.1 Mill Certified Inspection Report issued by Ormet Aluminum Mill Products Corp. dated
05/04/94 fix Aluminum Alloy 3003 -1 -114
8.3.2 Certified Test Report prepared by Q C Metallurgical, Inc. (QCM) Order No. 4GM -1944 dated
07/28/94 for samples 1/94070103 -(1) and 1/94070103 -(2).
APPROVED
EXPIRES : Dec, 13, 1996
2b -
ULTS:
1 9 1 94'
it Diamond, P.E.
Supervisor
Product Control Division
1.
4 -
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
Extension of Acceptance may be considered after a new application has been filed and the supporting
data, test report no older than ten (10) years, have been re-evaluated.
All reports of rc- testing shall bear the seal, signature and datc of an•enginecr registered in the State of
Florida.
2. Any revision or change in the materials, use, or manufacture of the product or process shall
automatically be cause for termination, unless prior approval is granted for revisions or change.
• 3. Any unsatisfactory performance of this product or process or a change in Code provisions shall be
ground for re evaluation.
4. Thi> acceptance shall not be used as an endorsement of any product for sales or advertising purposes.
5. The Notice of Acceptance number preceded by the words Dade County, Florida, and followed by the
expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance
is displayed, then it shall be done in its entirety.
6. A copy of this approval as well as approved drawings and other documents shall be provided to the
permit applicant by the manufacturer or his distributors and shall be available for inspection at the
job site at all time. The prints need not be rc- scaled by the engineer.
7 Failure to comply with Standard Conditions shall be cause for termination of Approval.
- 3 -
APPROVED
RP 1 9 1994
EXPIRES : Dec. 13. 1996
it Diamond, P.E.
Supervisor
Product Control Division
Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
rob Address 1091 OE 4 (o f.
�) Sec 3 '98 /0
Legal Description L 3t 4 P 1 k S o? of I'1 i GAM i 5h. re S
Owner/Lessee / Tenant DSV a Ci. O -Anna Ve (e z.
Owner's Address SCurA e C)OOV e_
Contracting
' (o,rnn i l � (C asS
Qualifier .G� J C U eX C Phone SD Co - -Aa
Conlj CwsclaI :Ulorfeer5
State # Municipal # ,30 `I Competency # 9 7 850o 3a y Ins. Co. ZarjcL tJ Amer it& : l t y
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one)(BUILDING� ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION a 1 %ZOntC I ( I e r'S a a Fl )(€d 1k +n010WS CR.Il Inn,pg0,�-
f�Q5 StUn1� 1
Square Ft. 1 % . Estimated Cost (value) 4.3,./51. 00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
s ture of owner and/or Condo President B at
an e
t;
�1z0 3 --ijo
as to Owner and/or Con President Date
Commission Expires: ;`1;�Y�oo• osa mm issi0n # D DO80001
I. Pal
_�:'�'••.G
Expires Dec. 2S, 2005
y 0.. ,/ ^ t Bonded Thru
°;; , % N. A tlan ti c Bonding Co., Inc
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
Building
Rio /no)—
CO N ry
637
Historically Designated: Yes No
• ;47 ,6::$. Bonded Thru
O' Atlantic Bonding Co., Inc.
C.C.F. � 0 NOTARY BOND 5 0 0 y
Tax Folio 1 1 3000 OIL 3“
Master Permit # ) C 'c ' 14 7 O
Phone 3 OS - s1 - 7S78
Address SO (13 8 , . # 10
der
as to Contractor or Owner - Builder
y Commission Expires:
TOTAL DUE
Date
4)411
ate
14p�1. Rosa I. Palados
y`.,$> �".Commission # DD080001
; � o � Expires Dec. 28, 2005
Plumbing Structural Engineer
0
0
2
ri!
[1:13:1332//SCISS.-
- .PIXED.I12119:12Sra
PAY
TO THE
ORDER OF
YAMILL GLASS & WINDOWS INC.
(305) 828-2121
480 W. 84ST. A-107
HIALEAH, FL 33014
FOR tb
UNION PLANTERS BANK
JtevivuL
•
1
0 L96311° 1.10 7008 4 11°9660 588000°
DATE
4
63-841/670
$
n:r2r.
DOLLARS
111•EIE
1963
IVP
Miami Shores Village
10050 NE 2nd Avenue
Printed: 8/23/2002
Applicant: SCOTT COUSINS
Owner: COUSINS SCOTT
JOB ADDRESS: 1091 NE 96 ST
Parcel # 1132060143660
Sign d
Building Permit
Phone: 305 - 795 -2204 Permit Number: BP2002 -1478
Contractor YAMILL GLASS & WINDOWS Contractor's Address: 15962 SW 48 AVENUE
Local Phone:
Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOTS 3 & 4 BLK 82 LOT SIZE IRREGULAR
Fees: Description 'Amount
FEE2002 -4717 Building Permit Application Fee $60.00
FEE2002 -4718 CCF $1.20
FEE2002 -4719 Notary Fee $5.00
FEE2002 -4752 Buildier's Bond $300.00
Total Fees: $366.20
Permit Status: Approved Permit Expiration: 2/19/2003 Construction Value: $2,000.00
Work: 2 HORIZONTAL ROLLERS & 2 FIXED WINDOWS ALL IMPACT RESISTANT
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 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 regu . '• ns pertaining to the overed 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, se J- employees.
u"" SPECTOR) BY: •�
Page 1 of 1
Total Fees: $366.20
Total Receipts: $0.00
• r
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, se, :n;s•�
(Contractor or Builder) BY: