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PLUMBINGPermit NiZ Size Septic Tank / 0 6 ----- Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. ------ ------- ) SS. 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Type of Tank Feet of Drain Tile ------ /1 Nature of Water Supply6tDWell Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) Repairs Date kpplit<tion i made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure her in 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 he complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at building during progress of work. Owner's Name and Address ' 4- - i No. - P , J.--- . Street _ .• , J. ."' ...1' __ ------- ___ / Registered Architect and/or Engpeer / ..,/ Employing Plumber's Name ", _ T.. //,." / No t 4 Street .e _ _._ _ . ___._ .____ ,' 1 . , , : 7 j 7 _-_. .1 _. Subdivision/k '5 ., /,. il I' Location and Legal Description Lot _,..2.__ T i '--, .' : Block ' . ,. .,. Street and Number where work is to be performed—No._— _ _ ___ ________..-____.:„...—:____ Street J / .' , .. , No. Capacity Gals. ^; of Stories f kigned) -- 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 com- plied with the provisions thereof, and will require similar compliance from all contractors or sub 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 arc required by the Act. The undersigned agrees to employ only such sub-contractors, pn work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Piumbini Master Plmnber. 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. 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. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDR TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS 1 :,.. TOTAL FIXTURES CONTR. LIST ) / - 75 15 --a.:-- l •.o. / i CHECK J 7 / 04e) -.... SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW I M 'G POOL CONTR. LIST / . / . CHECK j 80 / 0 0 Permit NiZ Size Septic Tank / 0 6 ----- Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. ------ ------- ) SS. 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Type of Tank Feet of Drain Tile ------ /1 Nature of Water Supply6tDWell Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit (Signed) Repairs Date kpplit<tion i made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure her in 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 he complied with, whether herein specified or not. A copy of approved plans and specifications must he kept at building during progress of work. Owner's Name and Address ' 4- - i No. - P , J.--- . Street _ .• , J. ."' ...1' __ ------- ___ / Registered Architect and/or Engpeer / ..,/ Employing Plumber's Name ", _ T.. //,." / No t 4 Street .e _ _._ _ . ___._ .____ ,' 1 . , , : 7 j 7 _-_. .1 _. Subdivision/k '5 ., /,. il I' Location and Legal Description Lot _,..2.__ T i '--, .' : Block ' . ,. .,. Street and Number where work is to be performed—No._— _ _ ___ ________..-____.:„...—:____ Street J / .' , .. , No. Capacity Gals. ^; of Stories f kigned) -- 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 com- plied with the provisions thereof, and will require similar compliance from all contractors or sub 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 arc required by the Act. The undersigned agrees to employ only such sub-contractors, pn work to be performed under this permit, as are licensed by Miami Shores Village. My Commission Expires Notary Public, State of Florida Piumbini Master Plmnber. 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. 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. t • • • 7 f 4/ cd" • • „; Date Job Address /3 v ,a C-. !7 C ' Tax Folio Legal Description Owner/Lessee / Tenant / 6 -r % 1 e-/ { r/ Owner's Address /30 Art. e° Contracting Co. 4 Signature No My Comnu PERMIT APPLICATION FOR MIAMI SHORES VILLAGE l F Address /e(O , S .— n.-1— c v / . ( ce-- SS# - - Phone 364 C'( 6 2 State #SC 0 co 2,93 9 Municipal # Competency # Ins. Co. Address Address Qualifier ,- lD C . A ivt Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL (PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ) 1 < i X11= t`+� �S'�/L�� /LL -�yJ', —Z o ,� 11,4-- ✓ ,t.z-77v ,,t6I...r.z.)lL L poi 0 ,d Square Ft. Estimated Cost (value) ! / 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 OF 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. d/or Condo President Date 7 do President Date Dagoberto F Guardia **My Commission CC750345 �+. „,,e y � June 11, 2002 \ ^ -r / � E FEES: PERMIT . 6 RADON &/o7 /0 Dv C.C.F. /P 2/ Signature of Notary My Comma APPROVED: Zoning Building Mechanical Plumbing Historically Designated: Yes No Master Permit # 6 q 1 , Phone Electrical Owner - Builder er- Builder Dagoberto F Guardia **My Commission CC750345 „ Expires June 11, 2002 NOTARY ) BOND Ov D•te Structural Engineer • • V MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 'A •[; 7._... � ._______ .._' Date Application is hereby fca the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structu :. i — rein described. Th.z3 application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all gcovisions 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 wjtll, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. )// Owna "s Name and Address �� ° - -- � -� " � ' � ° �� == -- - No. — Street Registered Architect and /or Engineer J / . Employing Plumber's Name._- -...., Street._-- -- -- - • Location and Legal Description Lot_ . -__— ..... __ _ -_— Block J! = __ Subdivision Street and Number where work is to be performed— No.___1� _� _ ' �•_ Street State work to be performed and purpose of building (By Floors) New Building-.----- --- --- - --- -- - - - - - -- Remodeling- _ --_ — — -- -- Addition Type an Feet 0 " .-' i� i t. off` from Well Ta or I)rrain d of Drain Tifle - -� Feet o _ < -- - --- _-- ---- -- - -- _. Sidi of Soakage Pit Size Septic Tank_ Nature of Water Supply: City —Well A$ncum: of Permit $ My Commission Expires Repairs (Signed)- ��- I No of Stories Capacity Gals. / Plumbing 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 5988, Compiled General Laws of Florida Permanent upplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ d by him in the work to be perform under this permit; and will post or cause to be posted' for inspection on the site of the work such p lic notice or notices as are ,;eraked by the Act. The undersigned agrees to employ only such sub - contractors, on work to be perforr d under this permit, as are f,i by Miami Shows Waage. �� / (Si srled) -� -_� ��'.. —__ �2 / Master Plumber. STATS OF FLORIDA, COUNTY OF DADE. 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. Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made - necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOf36T6 DAA• TUMN GS .SHOWERS TORIELAVS SINKS SLOP SINKS LAUNDRY TUBB URINALS CATCH BASIN FLOOR DRAIN DRINKING FO TOTAL FIXTURES CONTR. LIST ! C:t&Ltt -- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL LIST _ — CC4ZCK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 'A •[; 7._... � ._______ .._' Date Application is hereby fca the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structu :. i — rein described. Th.z3 application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all gcovisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied wjtll, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. )// Owna "s Name and Address �� ° - -- � -� " � ' � ° �� == -- - No. — Street Registered Architect and /or Engineer J / . Employing Plumber's Name._- -...., Street._-- -- -- - • Location and Legal Description Lot_ . -__— ..... __ _ -_— Block J! = __ Subdivision Street and Number where work is to be performed— No.___1� _� _ ' �•_ Street State work to be performed and purpose of building (By Floors) New Building-.----- --- --- - --- -- - - - - - -- Remodeling- _ --_ — — -- -- Addition Type an Feet 0 " .-' i� i t. off` from Well Ta or I)rrain d of Drain Tifle - -� Feet o _ < -- - --- _-- ---- -- - -- _. Sidi of Soakage Pit Size Septic Tank_ Nature of Water Supply: City —Well A$ncum: of Permit $ My Commission Expires Repairs (Signed)- ��- I No of Stories Capacity Gals. / Plumbing 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 5988, Compiled General Laws of Florida Permanent upplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employ d by him in the work to be perform under this permit; and will post or cause to be posted' for inspection on the site of the work such p lic notice or notices as are ,;eraked by the Act. The undersigned agrees to employ only such sub - contractors, on work to be perforr d under this permit, as are f,i by Miami Shows Waage. �� / (Si srled) -� -_� ��'.. —__ �2 / Master Plumber. STATS OF FLORIDA, COUNTY OF DADE. 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. 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. MIAMI SHORES VILLAGE. BUILDING ❑ ELECTRICAL ❑ PLUMBING PERMIT N? 9007 ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building CONTRACTOR OR BUILDER Bl. Work to be performed under this Permit Subdi- vision FLORIDA Sq. Ft Value of Project $ DATE. 195 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 JILDING ECTRICAL UMBING :gal Lot Bl. oscription dress of iilding_ MIAMI SHORES VILLAGE, FLORIDA DATE 194_ PERMIT N? 8558 Work to be performed under this Permit wner of iilding - chitect infractor Builder Subdi- vision Value of Project 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 appli- tion heref or in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any =ins, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked 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 rmit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and - pertaining In the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- iility for work done by his agents, servants or employees. Signed: By INSPECTOR Contractor's License No. 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 rtaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. acoeIng this pr Ltys.sume respons' ility for all work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY L Permit No 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 Amount of Permit $ ......... STATE OF FLORIDA, } COUNTY OF DADE. IAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r ;u•�a�lJ9l1 Registered Architect and /or Engineer______..- �,._____ d _ _____.._ -__ Employing Plumber's Name �c _ r ��_`4l r _ 2. _ LL. _ No.___.._-- _---- - - - - -_ _ Street_ _- - Location and Legal Description Lot___ Block Street and Number where work is to be performed —No rs, - a State work to be performed and purpose of building (By Floors) No. „,2 Streeter Subdivision. ------•--•------------.__----- j d v � eet New Building __.__. Remodeling _______.__._______._.._ Addition._- __.._._ Repairs No. of Stories Sirra Septic Tank _ y Type of Tank___ Feet of Drain Tile .1 d // _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__._____ _ ____Size of Soakage Pit Capacity Gals (Signed) - -- — y _ ...... ........ Plumbing 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 Pefinanent Supplement, and h,as com- plied 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( S i g n e d Date�� My Commission Expires Notary Public, State of Florida Master Plumber. 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBE SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE UR CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTD. LID? CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK CHECK L Permit No 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 Amount of Permit $ ......... STATE OF FLORIDA, } COUNTY OF DADE. IAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r ;u•�a�lJ9l1 Registered Architect and /or Engineer______..- �,._____ d _ _____.._ -__ Employing Plumber's Name �c _ r ��_`4l r _ 2. _ LL. _ No.___.._-- _---- - - - - -_ _ Street_ _- - Location and Legal Description Lot___ Block Street and Number where work is to be performed —No rs, - a State work to be performed and purpose of building (By Floors) No. „,2 Streeter Subdivision. ------•--•------------.__----- j d v � eet New Building __.__. Remodeling _______.__._______._.._ Addition._- __.._._ Repairs No. of Stories Sirra Septic Tank _ y Type of Tank___ Feet of Drain Tile .1 d // _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City — Well.__._____ _ ____Size of Soakage Pit Capacity Gals (Signed) - -- — y _ ...... ........ Plumbing 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 Pefinanent Supplement, and h,as com- plied 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 sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. ( S i g n e d Date�� My Commission Expires Notary Public, State of Florida Master Plumber. 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. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty materials and /or workmanship. PE Job Ad Legal Owner Owner' State # v v sr Pest Control Real Estate Reports Architect /Engineer Bonding Company Mortgagor ALERT /LEAR Pest Control JONATHAN JORDAN Representative Alert Lear Pest Control 505 N.W. 103 Street Miami, FL 33150 Phone (305) 751 -1700 THE TERMITE AND PEST CONTROL EXPERTS ContrauLing co aL Address . STO 1. Qualifier l/� .1 ".�iv�.r'� �rjj'' Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL WORK DESCRIPTION ,u72/J7 l/ � jy+/ L. 6/9,P Square Ft. Estimated Cos tj 87 l)v 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 (]:F 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. 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 dine in compliance with all applicable laws a lating construction and zoning. Furthe .• _, I authorize the above -named contractor to e work stated. of Owner Zoning and /or nature Date: Notary as to Owner and /or My Commission Expires: * * * * PERMIT FEE: APPROVED: Mechanical is-4 President Como , * Condo Termite Control Fumigation VICIPALITIES OF DADE COUNTY RETAIN COPY) Vgle/ Tax Folio# f /, /S aster Permit A_WS phone O3 7J > ss#/7.9 ` - ' 6 phone 7J// ?OD Competency# Ins. Co. Address Address Address PAVING FENCE SIGN I l.natu o f Contractor or Owner - Builder 41 0 " Pate: Notary as to Contractor or Owner- Builder My Commission Expires: ROT Y Pgfllt $TATf �FL4tTM um * * * *Iy tolNI961QA fly ' SON O Mai SO IRS,. Other ,)1t,)9k- cutclo P Electrical Pl Enginee! ' ng