361 NE 97 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
- • / , 1 q l
Date 9/ S / Address \ \ --1 �T Tax Folio
Legal Description Historically Designated: Yes ✓ No
Owner/Lessee / Tenant Q4
Owner's Address 3 6 k ' , V E 1 l
Contracting Co C L C (&
Qualifier � NtS
Square Ft. Estimated Cost (v
Signature of owner and/or Condo President Date
APPROVED:
Zoning Building
Mechanical Plumbin
Master Permit #
SS # � - Phone 2-Ca � - (41:
State # Municipal #-3 0 - ` 69 7 k eompetency # v (7 45
Electrical
Ins. Co.
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires: My Commission Expires:
Phone
Address \?- , 32_ `
00 b G 9 8— Address
Architect/Engineer
Address
Bonding Company
Mortgagor Address
Permit Type (circle one): : MELDING ELECTRIC
WORK DESCRIPTION
PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN
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.
Signature of Contractor or Owner - t .. er Date
FEES: PERMIT RADON C.C.F. '0 NOTARY BOND
TOTAL DUE
Engineering
i 77.4
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PLUMBING
ADDENDUM TO EUILD►_NC PERMIT APPLICAiI0N
CVE'!
,UTE: ::EAR
ELECTRICAL
1OTTiS a- I
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WIT CRS S J ` 3- i HP
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MECHANICAL
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71E :WEE:TIM
•
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date (\ C1.1 Job Address (j ( U ` W 'fax Fo
Legal Description L_ O k' • ` LID • ,Q ao L- - S e `Historically Designated:
Owner/Lessee / Tenant
Owner's Address 2 (..n k. • C . •
•
Contracting Co. c V ` ` e �Q� R ,.i . y-' �- Address
Qualifier � " 'IP"(!r<<'S ``Cot N S s
State # ()V S°
Architect/Engineer Address
Bonding Company Address
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL �LUMBIr MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost (value) <' 00 • 0
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.
71:?
s ature of owner and/or Condo President l a te
otary as to Owner and/or Condo President /D ate
My Commission Expires: %7
FEES: PERMIT ,3 cS" RADON
Municipal # Competency # Ins. Co: AAA ls, – CA R.i a(
Address
Phone
ignature of Contractor or
1
C.C.F. NOTARY �� BOND
TOTAL DUE 41G �
APPROVED:
Zoning Building
Mechanical Plumbing - y
/13 ?0 12 7o
Yes No
Master Permit #
Z.22to S• �,.' • \3z 8 (3.
Phone .N 2- 4
4
er- Builder
SGL
Notary as to Contractor or Owner - Builder
My Commission Expires:
Electrical
Date
7/77 Dto
9. 7
Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 2 3 I (97 Job Address 3 6 ( tic C / Tax Folio ix
Legal Description 1 Historically Designated: Yes No
Owner/Lessee / Tenant f � t/ / i to 6 6 o Master Permit #
[ —
Owner's Address 3 6 / q7 /24 I S !'J� t` - qs g — 7 --- 6 2
Contractin Co. (37I93 CN // C) s C � Address 6 v �) W Q (fit / tuAdy
Qualifier C. C/ -,-- D . Nay a y ssi __, phone/'()4 / 7
J
fr
State #- 60 /r Municipal # Competency #
Address
Address
Ins. Co. 4'
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL P T MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION b Se 0 )OD 1 Cj/1 � � 44° //a/f-.1 4/1/t/
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 (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.
ture of o
and/or
//-
'�!a's Con
e r an .s'1'y!!Q _Ptesidet
p a
O 1D . g iZ�
of (7:',!',1I3∎i't%'L
y Commis
FEES: PERMIT / RADON
APPROVED:
Zoning
Mechanical
��0 9Z
President ate
- 02.3
Building
ignature of Contractor or
o Contractor • r
y Commission Expires
C.C.F. • / NOTARY
Electrical
s + � 1t�Y' c
r J
lder ate
BOND
TOTAL DUE
V1ft7
Plumbin Engineering
Pan • rally.
SECTION
SCALE Nils `S
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MAAMI S#b✓lc -FL 331323
PASS ✓Q U
DATE
2 —J 7
SHEET/ f
0
J.O.
A.F.E.
•
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SECTION
SCALE Nils
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MAQOMI 30)✓lc°S -FL 3313
PAss ; 1r
vat-LL.
DATE.
SHEET
J �
A.F.E.
BUILDING ❑
ELECTRICAL
PLUMING C'
ROOFING
Owner of
Building `,;t Q O1,Y •
Architect
Contractor
or Builder
Legal
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
DA 1
❑ PERMIT IN? . 11201
Contractor's
Licatse No.
❑ Work to be performed under this Permit
amucry Tr
Lot J BZ.
ea
40 - € 1
This permit is -granted to the contractor ir builder named above to construct the building or to install the equipment or device deserffied In
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be if the work is not done in compliance with such ordinances or if the plans are changed without authorisation. A further condition upon which
granted is the understanding that the contractor or builder named above, assumes the res ty for thorough knowledge of the ordfrrathees ii
pertaining to the work covered hereby whether shown on the plans or drawings or in the , pecificaeions that he assume t1
done by his agents, servants or employees.
-
Value of
Project $
BY
Amt. of
Permit
AU11IoturT
In consideration of the issuance to me of this permit I to per the work covered hereunder in wt'npliance with all ordinaaun
pertaining thereto and in strict conf x ,, ty with the ns, dra wing` or specifications submitted to the proper authorities of Miami
In a • • •, ' I eibrlify ;L work done by myself, my agent, servant or employee.
UILDING
LECTRICAL
LUMBING
wner of
wilding
*Chitect
ontractor
e2fisoolheekoesi
Builder
.egal Lot I BL
)escription
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, rLoRIDA
DATE ? ""! 3 ;
Contractor'. �' /�
License No.
ERMIT N° 5576
Work to be performed under this Permit
ddress of 6 / ) ; 1 1- +�. P II .,
;wilding
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described
-lion herefor in strict compliance with all ordinances pertaining thereto and with the u d ding that the work be performed in • .
=ens, drawings, statements or specifications that may have been the - municipal ate. This Permit
e any time if the work is not done in compliance with such ordinances plans are l t authorization. A further
erm cur
it is granted is the understanding that the contractor or builder assumes the j• t. for a
ulations pertaining to the work covered hereby whether shown on the plasis'i a1f° litateznents or speellioations
i+ility for work done by his agents, servants or employees.
BY
S ., B
In consideration of the issuance to me of this permit I agree to perform the work covered . in conopliance with all ordinances
pertaining thereto and in strict conformity with, the plans, drawings, statements or specifications , to the proper authorities of Willi
accepting this permit I assume responsibility- for all work done by either myself, my agent, ierva t aE employee.
UILDING
LECTRICAL
LUMBING
!caner of
uilding
rchitect
!contractor
, Builder
legal
escription
MIAMI SHDR FLORIDA
sei PERMIT N? 5397
Work to be performed under • this Permit
,,
. /v
Lot
�sildingof ` �C value of , f,`
Project Permit
This permit is granted to the contractor or builder named above to construct the building or to install the
_no herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work'
tans, drawings, statements or specifications that may vha a een -submitted to and approved . the pnwaicip4 a' k►
any time if the work is not done in compliance with such ordinances o if the plans stir , i u
: rmit is granted is the understanding that the contractor or builder named ab
julations pertaining to the work covered hereby. whether shown. on the plans
hility for work done by his agents, servants or employees. ;
Signed:
� I art ran
` fi r 7 '^ 'c •
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all
artaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities •
ass
accepting this permit I assume' responsibility for all work done by either myself, my agent, servant or employee.
•
•
CONTRACTOR OR summit
Subdi-
vision
BY
•
DATE
By
7
Contractor's
License No f 3►`° :
equipment or device described
w � •eit. `'his Permit
be performed in
AUTSOSUTY
1
•
•
DATE N0. 611
f ..
ISSUED TO
to install the following described plumbing, in accordance with
the laws, statutes and regulations of Miami Shores Village,
Florida and the State of Florida, governing plumbing and drain-
age work done in Miami Shores Village, Florida,
FOR A STORY BUILDING AT
FIXTURES
S
SEWER
SEPTIC TANK
TOTAL $
VILLAGE PLUMBING INSPECTOR
MIAMI SHORES VILLAGE
PLUMBING PERMIT
U
BY
BUILDING 0
PLUMBING
ROOFING
Owner of
Building \.\
Architect
MIAMI SHORES VILLAGE, FLORIDA
ELEAL CTRIC
vPERMIT N? 15861
DA
0 Work to be performed under this Permit
Contractor
or Builder A
Legal Lot SI. Subdi-
Description vision
Address of ('
Bu ilding ' ilia 1 t.
*' . - C- ' 1 I ' f -
This permit is granted to the contractor or budder named above to construct the building or to install the equipment or device described in ihe tproliention ..;-
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wM be performed in compliance with.
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be
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
granted is the understanding that the contractor or builder named above assumes the responsibdity for a thorough knowledge of the ordlnances
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he amtunes
done by his agents, servants or employees.
Signed • ' ; iNspacit 'i .,,..... BY 4 ''' oti..-•""
S
-
L
In consideration of the issuance to me of this permit I agree to p the work covered hereunder in compliance with all ordinances and -,K,
pertaining thereto and in strict conformity with the plans, drawings, etattents or specifications submitted to the proper authorities of Miami 'Shorts tl
In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
) LA 4 SY — '
CONTRACTOR OR BUILDER '' ' AUTHORITY
Contractor's
License No._
Value of Amt of
Project $ Permit
$ 4j"484‘
Permit No.
Owner's Name and Address ..
Registered Architect and /or Engineer .__ _ -- -__ - -- -- • - -_ -- , - _ _ _ - _ - - . - - __._.._.._—
Employing Plumber's Name/43AMJ _ k xa 1 „ e r_r of � �_... No
Location and Legal Description Lot .
State work to be performed and purpose of building (By Floors)—L
New Building Remodeling - Addition__._
Size Septic Tank.
Feet of Drain Tile
Nature of Water Supply: City Well
Amount of Permit $-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
A c' k'1611.:
1
Repairs
Date
_Type of Tank_
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
96 3
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, Floridu
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 Divisior
of Miami Shores Village shall be complied with whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
/ T�
No.i-._ -- ___ Street. __I___ -__!_3 /
--
� street_._ ltr�t s r
Block._._ _ _ Subdivision
Street and Number where work is to be performed —No _ _ _ __ __'” Street . 1
Capacity Gals.
My Commission Expires Notary Public, State of Florida
No. of Stories
Plumbing Insi:e.t,.r.
The undersigned applicant for this building permit does hereby cer.ify that he understands and accepts his obligu'lons as Is employer of labrr
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and h;;,
plied with the provisions thereof, and will require similar compliance from all contractors or sub contractos.s.enployed by him in the we'ls :o be
performed under this permit; and will post or cause to be posted for inspection o. . rte of the w• suc public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, • I work t. • p d under this r' rmit, as an
licensed by Miami Shores Village.
(Signed) - --
-"t aster Plumber.
STATE OF FLORIDA, } u.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 at
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 .mproper notice for inspection, or t..ul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
Tula
URINALS
U
CATCH
BASIN
FLOOR
DRAIN
ORiNKINO
FOu N';
TOTAL
FIKTUREI
CONTR.
LIST
__
CHECK
_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H ATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM O
POOL
CONTR.
LIST
CHECK
Permit No.
Owner's Name and Address ..
Registered Architect and /or Engineer .__ _ -- -__ - -- -- • - -_ -- , - _ _ _ - _ - - . - - __._.._.._—
Employing Plumber's Name/43AMJ _ k xa 1 „ e r_r of � �_... No
Location and Legal Description Lot .
State work to be performed and purpose of building (By Floors)—L
New Building Remodeling - Addition__._
Size Septic Tank.
Feet of Drain Tile
Nature of Water Supply: City Well
Amount of Permit $-
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
A c' k'1611.:
1
Repairs
Date
_Type of Tank_
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)
96 3
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, Floridu
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 Divisior
of Miami Shores Village shall be complied with whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
/ T�
No.i-._ -- ___ Street. __I___ -__!_3 /
--
� street_._ ltr�t s r
Block._._ _ _ Subdivision
Street and Number where work is to be performed —No _ _ _ __ __'” Street . 1
Capacity Gals.
My Commission Expires Notary Public, State of Florida
No. of Stories
Plumbing Insi:e.t,.r.
The undersigned applicant for this building permit does hereby cer.ify that he understands and accepts his obligu'lons as Is employer of labrr
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and h;;,
plied with the provisions thereof, and will require similar compliance from all contractors or sub contractos.s.enployed by him in the we'ls :o be
performed under this permit; and will post or cause to be posted for inspection o. . rte of the w• suc public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, • I work t. • p d under this r' rmit, as an
licensed by Miami Shores Village.
(Signed) - --
-"t aster Plumber.
STATE OF FLORIDA, } u.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 at
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 .mproper notice for inspection, or t..ul
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Ar
C r
uilder
Legal
Description
Lot
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 5576
Work to be performed under this Permit 1 '
J
#‘•
Bl.
Subdi-
vision
DATE S 3 1 947_
Contractor's /s . 7 /
License No.
r
Address of '� 1 �f,� Value of Amt. o 7
Project Permi
Building 6 / 7 w'" t.'
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-
cation 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 o awings or i the statements or specifications hat he a
Signed: s respon-
sibility for work done by his agents, servants or employees. � w ��j
� By *� ' 7 11
INSP OR
In consideration of the issuance to me of this permit I agree to perform the work covered h under in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autl ges of Miami Slrer glaget
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
'-)
BY
AUTHORITY
M
BUILDING
ELECTRICAL
PLUMBING
Owner of
i Building
Architect
Contractor
olletuilder
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE / 1947_
PERMIT N? 5581 L n a s /6 9s'
Work to be performed under this Permit
/ r •) .3,6_4(few.e.g
Legal Lot V Bl.
Description
Budins of t4' 7 9 7 � Value Project of Amt. of/ Q
Z' J • • 7 �" Pro act 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-
cation 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 chan:edwi out au ization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above a es • - espo j : ility a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or • .w . t?' • s•ecifications and that he assumes respon-
sibility for work done by his agents, servants or employees. ���
Signed: /��� `j /1 By
!v •' CTS R
Subdi-
vision
Q dcLi.�cn,
In consideration of the issuance to me of this permit I agree to perform the wa cove d hereun•er in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specific ions submitted to the proper authoft of Miami Shoes uilj�ge.,,
In accepting this permit I assume responsibility for all work doe by ither myself, my a ent, servant or employee. . U
t-
--1- .rt , l ! l J .? ti,
AUTHORITY
4
BUILDING
ELECTRICAL\
PLUMBING
Owner of
Building
Architect
Contractor '-
or Builder (f'� -�' ��"" 7-64,
Legal Lot Bl.
Description
Building of j?‘ / . 0 • 97 - 1' P roject f 1 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-
cation 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 th ordinances and
regulations pertaining to the work covered hereby whether shown on the plan drawings or in th statements or specification and that h umes respon-
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT X? 5397
Work to be performed under this Permit
Subdi-
vision
1.^ L t 1 BY
V2
DAT* 194
Contractor's t 7 /
(�
License No. ✓
1
AUTHORITY
sibility for work done by his agents, servants or employees. /, i
Signed. • a. of By
.IASP OR
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 nua of Miami Shores. Village.
In accepting this permit I assume responsibility for a work done by either myself, my agent, servant or employee.. .0 0
Permit No 3 q
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 $uilding 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 No
Registered Architect and /or Engineer
New Building Remodeling Addition Repairs.
Size Septic Tank Type of Tank__ Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Wat Supply: City —Well.
STATE OF FLORIDA,
J ss.
COUNTY OF DADE.
•)
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size of So
age Pit_
L ,
Amount of Permit $__ -- ---- --- - -- - -- ( Signed) _
Date
•
Street
Employing Plumber's Name No. Street
Location and Legal Description Lot _ Block i Subdivision ,.,.. _._,....
Street and Number where work is to be performed—No
______ _` "_ ___�____�___�_�: Street
State work to be performed and purpose of building (By Floors) �.�
No. of Stories
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 Permanent Supplement, and has 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.
( Signed) 6e AAA
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.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
•
.
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
�
7
wit
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No 3 q
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 $uilding 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 No
Registered Architect and /or Engineer
New Building Remodeling Addition Repairs.
Size Septic Tank Type of Tank__ Capacity Gals.
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Nature of Wat Supply: City —Well.
STATE OF FLORIDA,
J ss.
COUNTY OF DADE.
•)
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size of So
age Pit_
L ,
Amount of Permit $__ -- ---- --- - -- - -- ( Signed) _
Date
•
Street
Employing Plumber's Name No. Street
Location and Legal Description Lot _ Block i Subdivision ,.,.. _._,....
Street and Number where work is to be performed—No
______ _` "_ ___�____�___�_�: Street
State work to be performed and purpose of building (By Floors) �.�
No. of Stories
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 Permanent Supplement, and has 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.
( Signed) 6e AAA
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.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No 5 7 t
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City-Well
Amount of Permit $___ - (Signed)'
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
Date _ - 7
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 No.
Registered Architect and/or Engineer
Employing Plumber's Name 2(JO C /./Aec • No. 4.6 Street.L ML
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed-No. Street
State work to be performed and purpose of building (B
New Building Remodeling
Addition Repairs 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 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-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.
Master Plumber.
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
-7F
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.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOU NT• NIS
WASV1(1/•
pd.
-.Z--
.
TOTAL
FIXTURES
CONTR. LIST
-/---
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
/
CHECK
X 1 1
_
.0..
r r
Permit No 5 7 t
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
Nature of Water Supply: City-Well
Amount of Permit $___ - (Signed)'
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)
Date _ - 7
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 No.
Registered Architect and/or Engineer
Employing Plumber's Name 2(JO C /./Aec • No. 4.6 Street.L ML
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed-No. Street
State work to be performed and purpose of building (B
New Building Remodeling
Addition Repairs 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 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-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.
Master Plumber.
STATE OF FLORIDA,
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
-7F
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.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty
materials and/or workmanship.
CHECK iry :,
Permit No. ` g
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___,___ •_� -- _��'_.__ _cw No. Street -- , -__,
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot_____________
Size Septic Tank
Feet of Drain Tile
Amount of Permit
STATE OF FLORIDA, 1
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Street and Number where work is to be performed -No
State work to be performed and purpose of building (By Floors )__________ ---- ___ ...
_._._
New Building -- Remodeling_ -_-_ _-_- Addition_ -_- -•__
No.____...- .------ ._._._ Street._ _ -_...
Block_ Subdivision ....... ---- ......
__•--- - - - - -- .._....
r'
Street . •+-= - - - - -w - •- -• - ----
(Signed)
(Signed) —
Date_- - - -- ` ? ' ,1
Repairs No. of Stories.
My Commission Expires Notary Public, State of Florida
Type of Tank__ Capacity Gals.
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City-Well. __ _ _- Size of Soakage Pit
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 Permanent Supplement, and has 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.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknow;edgments, 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 T
BATH L
SHOWERS T
LAVA. S
SINKS S
SLOP L
LAUNDRY C
URINALS B
CATCH F
FLOOR D
DRINKING T
TOTAL
CONTR.
LIST
CHECK
- S
SEPTIC S
SEWER D
DRAIN S
SOAKAGE G
GREASE S
SOLAR D
DEEP S
SPRKLR. S
SWIM'G
corm. +
+� / -
-- - _
Permit No. ` g
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___,___ •_� -- _��'_.__ _cw No. Street -- , -__,
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot_____________
Size Septic Tank
Feet of Drain Tile
Amount of Permit
STATE OF FLORIDA, 1
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Street and Number where work is to be performed -No
State work to be performed and purpose of building (By Floors )__________ ---- ___ ...
_._._
New Building -- Remodeling_ -_-_ _-_- Addition_ -_- -•__
No.____...- .------ ._._._ Street._ _ -_...
Block_ Subdivision ....... ---- ......
__•--- - - - - -- .._....
r'
Street . •+-= - - - - -w - •- -• - ----
(Signed)
(Signed) —
Date_- - - -- ` ? ' ,1
Repairs No. of Stories.
My Commission Expires Notary Public, State of Florida
Type of Tank__ Capacity Gals.
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City-Well. __ _ _- Size of Soakage Pit
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 Permanent Supplement, and has 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.
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknow;edgments, 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.
•
MIAMI SHORES VILLAGE
PLUMBING PERMIT
DA'L'E ! NO. 6 Y
ISSUED TO
to install the following described plumbing, in accordance with
the laws, statutes and regulations of Miami Shores Village,
Florida and the State of Florida, governing plumbing and drain-
age work done in Miami Shores Village, Florida.
FOR A STORY BUILDING AT
FIXTURES'
FIXTURES $
SEWER . $
SEPTIC TANK $
TOTAL $
VILLAGE PLUMBING INSPECTOR
BY ,� 7
I herewith submit the following applica ion for a permit overing
the installation of a Septic Tank
Soakage Pit: : Relaying:
Feet of drain tile: (7
Installed by:
•
Building has:
Bedrums
Owner or Agent:
Lot No.
Size of Soakage Pit:
Remarks:
PERMIT NO. i/C
M1AM1 8HUMEU
.62PaiiTiO Fat( SEIJTIC
410 DIVISION OF PLUMBINIIINSPECTION
(
(NEW: Old: Story:_
For a (Store: Garage: Apt:
(Res: Garage wash floor:
Stores;
Block No.
Address of work:,...54/4 • '
No. of Plumbing Fixtures:
Nature of water supply: City:
wells:
gallons:
Type of tank installed: Tank capacity in
Additional information:
c ( t' /
Rdy for Inspection: Date:
APPROVED BY: et
Dat
Address:
Offices; Apts; Hotel Rms;
f jf
SUB IVISION
7
Laundry Tubs: Floor Drains:
Well: Feet
Purpose of same:
f /,
Hotel:
11
New:
Addition: Remodeled:
Office Bldg.
'lasts water from a:
- /
Distant from all
1 c " () r'• / I
CONDEMNED BY:
Time:
4.• T,^ - A f d
BATH
ICLOSETS -NE's
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
— ceeer.
$ —•—'_�_
1
!�,,,,„
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
LIST
CHECK
_
___
el.; N .f . --
Amount of Permit $
« e'
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
rLgplicstfon ?s hereby ree a for the approval of the detailed statement of the plans and specifications herewith submitted or the building or other
struct.Lne 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.
OWrer's Name and Address
` _.,� __ _ No._
------ � °______ <� ��� ���'�� A. � -
Registered Architect and /or Engineer _ ---. -_
Employing Plumbers Name_._ _e_:.c + ., � s_f'ie`_„ .� et- _y / " fri 4 t
p 3'�g ' 'r' 1 '¢'� "� �'�� No.__— __.---- �-- ...�:'.__ _Street_. - -- — -
r _ Street
Location and Legal Description Lot._._ _.____ _____ _____ _ _ _.— Block
treat and Number where work is to be performed —No _.,: 61 Street_
a`ato work to be performed and purpose of building (By Floors)__ --_ .... -._... .Steed_@e_ J_/ A_/1
New Building__.._ ___. _.. Remodeling___ __ Addition--- ____._ Repairs -- No. of Stories... --------- - - - --- --
r
Size Septic Tank ---- ____ -- -Type of Tank.
Feet of Drain .............. _________Dist. Feet of Tank or Draiskield from Well
Nature of Water Supply: City — Well.---__-_ _ ..... _________ ....... _._ __..Size of Soakage Pit
(Signed)-
Capacity Gals._
Date
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perth
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors
performed under this permit; and will post or cause to be posted for inspection on the site of the work s
required by the Act. The undersigned agrees to employ only such sub - contractor vii work to be
licensed by Miami Shores Village.
My Commission Expires Notary Public, State of Florida
Subdivision--. __.____.._--- _._ ... __. ___ - -.
tee 41
, f 9
L-
Master Plumber.
—` e_
Plumbing Inspector.
ons as an employer of labor
t Supplement, and has cmn-
d by him in the work to be
notice or notices as are
under this permit, as are
( Sig:
&YAM OF FLORIDA, es. a
COUNTY OF DADE. }
Before me, the undersigned authority, a notary public, duly authorized to administr oaths and take acknowledgments , personally appeared
to tee 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
tcerein 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
matfzials and /or workmanship.
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE_
❑ PERMIT N? 13586
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building l r
❑ Work to be performed under this Permit
Architect
Contractor
or Builder ‘,,,,..4--.L.P.--. _1, '. - \'-- .-- `'.•^cam r ........
Legal Lot I) Bl.
Description
Address of t '
Building 4; ( ) - I 1 6 .
CONTRACTOR OR BUILDER
Subdi-
vision
Value of
Project $
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 phew
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at an
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 tbis'permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
pertaining to the work covered hereby whether shown on the plans or drawings 4n the statements or specifications and th a assumes responsibility worls
done by his agents, servants or employees.
BY
Contractor's
Limn* No.
II Amt of
Permit
Signed. I k, BY
In consideration of the issuance to me of this permit I agree to perm the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in atria 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.
AUTH 3 sir
Work to be performed under this Permit
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building -{
This permit is granted to the co r or builder named above to construct the
herefor in strict compliance with all since' pertaining thereto and with the and
drawings, statements or specifications 6 y have been submitted to and approved .
time if the work is not done in comtilianoSvith such ordinances or if the plus are C
granted is the understanding that the ocsiSsuctor or budder named above ammo the
pertaining to the work covered hat:17 shown on the plans oa drawings or in
done by his agents, servants or emp
In aderati
pertaining th
In acce
CONTRACTOR OR
Value of
Project
Signed:
nce to the of this permit I agree to perfq - the work covered hereunder in compliance with all o*dfaiensl t
nformity the plans, drawings, statement or lca ions submitted to the proper authorities of Minh t
ty for all work done by either, m , my agent, servant or employee.
BY
a
Atrraosrt t