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740 NE 96 St (2)ILUMBING Owner of Building Architect Contractor or Builder Legal regulations pertaining .Address of Building This �� ; the cation herefor is Don na wide plans, drawing', statements ar at an. time work is not done in permit is granted is the medwatonding to work work done by his agents, M1AMI RMIT N9 681 performed this P Description In consideration of the issuance to me of this permit I agree to pertgining thereto and in strict • . with the pleas, wdejlet ccepting this permit I assume M for all Work d a wl, BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building P Architect Contractor or Builder Legal Description Address of Building Lot 0 PERMIT N? 4080 1 .l. MIAMI SHORES VILLAGE, FLORIDA DATE ) - 2 r` 195 Contractor's License No. Work to be performed under this Perms / Bl. Subdi- vision Value of D G� FN Amount of Project $ •� 11 Permit $ This permit is granted to the contractor or builder named above to construe the building or to install the equ: or device described in the applauded herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with airy 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 thorou• . knoWlerige of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or no and that he assumes responsibility for work done by his agents, servants or employees. In consideration of the issuance to me pertaining thereto and in strict conformity with cepting this peruit I assume nsibility for ./ tit 4 CONTRACTOR OI}'UILDER Signed- INSP the plans, drawings, statements or specifications s BY ., I AUTHORITY of this permit I agree to perform the work covered = rounder in compliance w11f+ ordinances and regulations fitted to the proper authorities o Miami Shores Village. In ac- all work done by either, myself, my agent, servant or employee. Permit Nol_'..) 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 ���1 __ ll�.i/� � N 1f7_ ' No. Street Registered Architect and /or Engineer f _ ^ Employing Plumber's Name___ 29 `� t '�' � —_K No t J7f $ Street / � Location and Legal Description Lot Block. Street and Number where work is to be performed —No 7' y'' j‘ t _ State work to be performed and purpose of building (By Floors) 6r' bitS 19t Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well STATE OF FLORIDA, COUNTY OF DADE. ss. V D U My Commission Expires Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signedf ( Signed) Date _____ / Subdivision------------ - - - - -- - - - - - - — Street Type of Tank Capacity Gals 2 • Hi* 0p-- . Notary Public, State of Florida New Building Remodeling Addition Repairs N Stories Dist' Feet of Tank or Drain Field from Well j/j o Lt./ 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 em ?loyed 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 s 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 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 WERS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS U CATCH BASIN FLOOR DRAIN DRINKING FOU YT' NS TOTAL FIXTURES CONTR. LIST CHECK — SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST e CHECK Permit Nol_'..) 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 ���1 __ ll�.i/� � N 1f7_ ' No. Street Registered Architect and /or Engineer f _ ^ Employing Plumber's Name___ 29 `� t '�' � —_K No t J7f $ Street / � Location and Legal Description Lot Block. Street and Number where work is to be performed —No 7' y'' j‘ t _ State work to be performed and purpose of building (By Floors) 6r' bitS 19t Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well STATE OF FLORIDA, COUNTY OF DADE. ss. V D U My Commission Expires Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signedf ( Signed) Date _____ / Subdivision------------ - - - - -- - - - - - - — Street Type of Tank Capacity Gals 2 • Hi* 0p-- . Notary Public, State of Florida New Building Remodeling Addition Repairs N Stories Dist' Feet of Tank or Drain Field from Well j/j o Lt./ 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 em ?loyed 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 s 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 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. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No.. Date_ C Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildldg or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village. Pbxida. 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, whethe he rpiy pecified or not. A copy of approved plans and specifications must be inept at building during progress of work. Amount of Permit S. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot_ Street and Number where work is to be performed--N State work to be performed and purpose of building (By Floors) New Remodeling ____ _______ __________ __. Addition Repairs Size Septic Tan ___. -__. -_ Type of Tank Feet of Drain Tile__. __ _ __ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: CitykWell. _Size of Soakage Pit • /� Subdivisio Id_ £ Street_ (Signed) 1/1 No. of Stories-. _Capacity Gals My Commission Expires Notary Public. State of Florida The undersigned applicant for this building permit does hereby certify that 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 Permalaent 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 an required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed u r this permit, as us licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. as, Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peraoanlly 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. 1 CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES , CONTR. ■ LIST HICK SEPTIC TANK SEWER CONK. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP. WELL SPRKLR. SYSTEM SWIM'O POOL r CONTR. LIST" 44'...."'" . • . , CHECK 1 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No.. Date_ C Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the buildldg or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village. Pbxida. 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, whethe he rpiy pecified or not. A copy of approved plans and specifications must be inept at building during progress of work. Amount of Permit S. Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name Location and Legal Description Lot_ Street and Number where work is to be performed--N State work to be performed and purpose of building (By Floors) New Remodeling ____ _______ __________ __. Addition Repairs Size Septic Tan ___. -__. -_ Type of Tank Feet of Drain Tile__. __ _ __ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: CitykWell. _Size of Soakage Pit • /� Subdivisio Id_ £ Street_ (Signed) 1/1 No. of Stories-. _Capacity Gals My Commission Expires Notary Public. State of Florida The undersigned applicant for this building permit does hereby certify that 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 Permalaent 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 an required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed u r this permit, as us licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. as, Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peraoanlly 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. 1 BUILDING ELECTRICAL PLUMBING .. Owner of a Building Architect Contraetor or Builde Legal Description Lot CONTRACTOR OR B DER MIAMI SHORES VILLAGE, FLORIDA PERMIT N2 7030 Work to be performed under this Permit f r' B1. Subdi- vision In consideration of the issuance to me of this permit I agree to per pertaining thereto and in strict conformity with the lans, drawings, s In accepting • is permit I ass esponsibility for all work done by eithe Sign9di • BY DATE //," /6' I SPECTOR 1 94 Contractor's Li,eepse No. Value of Amt. of Project Permit Building of /. '`_ -�'. g This ermit is granted to the contracto of r builder named above to construct the building or to install the equipment ordeice described in tie 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 c ged • lout authorization. A further conditi upon which this m permit is granted is the understanding that the contractor or builder named above assurn the re o ibility for a thorough knowled e ordinances and regulations pertaining to the work covered hereby whether shown on the plans or u gs r statements," specifications e assumes respon- sibility for work done by his agents, servants or employees. the work covered hereunder in ccmpliance with all ordinances and regulations ents or specifications submitted to the proper authorities of Miami Shores Village. myself, my agent sajv t or employee. AUTHORITY Amount of Permit $ Permit No. __�, Owner's Name and Address STATE OF FLORIDA, ss. COUNTY OF DADE. Registered Architect and /or Engineer Employing Plumber's Name__ _ _ c Location and Legal Description Lot My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describ d. 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. RosQN 2Y 1 Date No 74. 0 NP _ ( Signed) Street lvrH1)13y 23 / __IA / street__ -,� Subdivision Street and Number where work is be performed —No State work to be performe nd purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories reet Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile 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. ( Signed) 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, thaw 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. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT'NS � I ( (,. FIXTURES CONTR. LIST , / 2 I L CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / CHECK Amount of Permit $ Permit No. __�, Owner's Name and Address STATE OF FLORIDA, ss. COUNTY OF DADE. Registered Architect and /or Engineer Employing Plumber's Name__ _ _ c Location and Legal Description Lot My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein describ d. 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. RosQN 2Y 1 Date No 74. 0 NP _ ( Signed) Street lvrH1)13y 23 / __IA / street__ -,� Subdivision Street and Number where work is be performed —No State work to be performe nd purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories reet Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile 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. ( Signed) 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, thaw 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. Permit No Owner's Name and Address__ STATE OF FLORIDA, COUNTY OF DADE. 3 ss. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING Ih PEC11ON DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is he by made for the approval of the detailed statement of the plans and specifications herewith subnfitted 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. - -mere ra "' f No. `9, Street .._ ?‘ 116 510** Registered Architect and /or Engineer v Employing Plumber's Name _____ _ Location and Legal Description Lot____ ____ a � - -- ----------------------- Block - - -- Street and Number where work is to be performed —No ( Signed) No _44 Date_,. Street Subdivision_ Capacity Gals. My Commission Expires Notary Public, State of Florida I Street_ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories U Type Size Septic Tank ..r,.� - yp of Tank_ y _l�•�L Feet of Drain Tile � Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well _____ —____— Size of Soakage Pit ( Signed) 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 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 LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS 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 Permit No Owner's Name and Address__ STATE OF FLORIDA, COUNTY OF DADE. 3 ss. Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING Ih PEC11ON DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is he by made for the approval of the detailed statement of the plans and specifications herewith subnfitted 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. - -mere ra "' f No. `9, Street .._ ?‘ 116 510** Registered Architect and /or Engineer v Employing Plumber's Name _____ _ Location and Legal Description Lot____ ____ a � - -- ----------------------- Block - - -- Street and Number where work is to be performed —No ( Signed) No _44 Date_,. Street Subdivision_ Capacity Gals. My Commission Expires Notary Public, State of Florida I Street_ State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories U Type Size Septic Tank ..r,.� - yp of Tank_ y _l�•�L Feet of Drain Tile � Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well _____ —____— Size of Soakage Pit ( Signed) 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 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. Owner of ' Building • 'BUILDING ELECTRICAL PLUMBING MIAMI SHORES VILLAGE, FLORIDA PERMIT N2 6819 Contractor's }} License 1o. L � r rifi er this Permit / L 4 Architect , Contractor or Builder Legal Description Address of --� Value of Amt. of ?LE- Building Project Permit 1 This er is ante to the contractor or bui der named above to construct the building or to install the equipment or evice described in the a li- p g q PP 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 .e revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authcrization. A fu er conditio. i . o ' which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough kn. ledge .J1 • f . . s and awings or in t e,stat nents or specifications ..1 respon- regulations pertaining to the work covered hereby whether shown on the plans or sibility for work done by his agents, servants or employees. Signed. Subdi- vision In consideration of the issuance to me of this permit I agree to perf6rm a work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statetn is or specifications submitted to the proper author ns of Miami Shores Village.,, In acceptin this permit I assume responsibility for all work done by either myself, my agent, servant or employee. 1.7 5 • CONTRACTOR OR BUILDER BY DATE By AUTHORITY 194 Permit No o Application is hereby made for the approval of the detailed statement of i r: structure herein described. This application is made in compliance and co* and edl provisions of the Laws of the State of Florida, all ordinances of Mie_m° of Miami Shores Village shall be complied with, whether herein specified building dur_ng progress of work. _ _ O*:✓raar'a Name and Address / -/ 1 • Registered Arch:;:ect and /or Engineer ..... --- ,-- - -__ -- _---- ___ - _ -- ��� ;;r.�;z;oyin;; Plumber's Name_�< Location and Legal Description Street and Number where work is to be performed —No 5tcte work :o be performed and purpose of building (By Floors)__- _-- .... __.____ -_ New Building ______ Remodeling - -__ ___ Addition. ..____.___ Size Septic Tank Amount of Permit $ 2. ?,'1`E OF FLORIDA, 1 1 13 , 9147Y OF DADE. MIAMI SHORES VIL..140 PLUMBING INSPECTION DEPARTME: APPLICATION FOR PLUMBING ' r Block_ Date dians and specifications herewith submitted for the building or other with the `' gilding Ordinance of Miami Shores Village, Florida, Shores Vivaa Lid all rules and regulations of the Building Division "r'. A copy qf approved plans and specifications must be kept at No. "/ (-,7 _.__. ... Street_A No/ .: Type of Tank__ Capacity Gals Feet of Drain Tile ._Dist. Feet of Tank or Drain Field from Well Repairs___ No. of Stories. (Signed) - Street_. _. Subdivision Street ,, - y .F Nature of Water Supply: City—Well. . Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts his o: gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 re,,utred 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. My Commission Expires Notary Public, State of Florida Plumbing Inspector. j ester Plumber. Bc oge roc, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to rna well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of kce clove described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts tLerE: '�zy dim stated are true. N3TE: 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 INALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK .. SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTE SW IM'O POOL CONTR. LIST _ -- CHICK Permit No o Application is hereby made for the approval of the detailed statement of i r: structure herein described. This application is made in compliance and co* and edl provisions of the Laws of the State of Florida, all ordinances of Mie_m° of Miami Shores Village shall be complied with, whether herein specified building dur_ng progress of work. _ _ O*:✓raar'a Name and Address / -/ 1 • Registered Arch:;:ect and /or Engineer ..... --- ,-- - -__ -- _---- ___ - _ -- ��� ;;r.�;z;oyin;; Plumber's Name_�< Location and Legal Description Street and Number where work is to be performed —No 5tcte work :o be performed and purpose of building (By Floors)__- _-- .... __.____ -_ New Building ______ Remodeling - -__ ___ Addition. ..____.___ Size Septic Tank Amount of Permit $ 2. ?,'1`E OF FLORIDA, 1 1 13 , 9147Y OF DADE. MIAMI SHORES VIL..140 PLUMBING INSPECTION DEPARTME: APPLICATION FOR PLUMBING ' r Block_ Date dians and specifications herewith submitted for the building or other with the `' gilding Ordinance of Miami Shores Village, Florida, Shores Vivaa Lid all rules and regulations of the Building Division "r'. A copy qf approved plans and specifications must be kept at No. "/ (-,7 _.__. ... Street_A No/ .: Type of Tank__ Capacity Gals Feet of Drain Tile ._Dist. Feet of Tank or Drain Field from Well Repairs___ No. of Stories. (Signed) - Street_. _. Subdivision Street ,, - y .F Nature of Water Supply: City—Well. . Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts his o: gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, 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 re,,utred 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. My Commission Expires Notary Public, State of Florida Plumbing Inspector. j ester Plumber. Bc oge roc, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to rna well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of kce clove described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts tLerE: '�zy dim stated are true. N3TE: 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. BUILDING ELECTRICAL PLUMBING Wetic to be performed under this i ,- it Owner of Building ' Architect Contractor or Builder Legal Description ,• i Address of Building Lot PERMIT N° 21t78 MIAMI SHORES ( Bl. Value of r P 4 Project In consideration of the issuance to me of this permit I agree to p tions pertaining thereto and in strict conformity with the plans, drawinar Village. In accepting this permit Uassume reiponsibili for all work &A Ar ril 00 / 4 1 CONTRACTOR BUILDER 4 .. • 4 ,.. , ...l 440. L' ''' 4- ILLAGE, FLORIDA DATE_ Contractor's Amt. of Permit This permit is granted to the contractor or builder named above to conatruct the building or to install the equipment or device described application herefor in strict compliance with all ordinances pertaining theta* and with the understanding that the work will be with any plans, drawings, statements or specifications that may have bees indisaiSted e and approved by the propel municipid authorities, be revoked at any time if the work is not done in compliance with such eit If plans are changed without authorisation. A upon which this permit is granted is the understanding that the contracot et bdSI nd above assumes the responsibility for a thoe the ordinances and regulations pertaining to the work covered hereby wbetbm skiers on Is plais or digs ot4n the statement, that he assumes responsibility for work done by his agents, servants or eitpAcierees. B iNspEcitin k covered hereunder in compliance with all ordinances and or specifications submitted to the proper authorities of Miami myself, my agent, servant or employee. Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Appl_cation 1 1:ereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng or other structure herein described. This application is made in comphance 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 th Building Di ' slon 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._ _.__ ..... Street Registered Architect and /or Engineer Employing Plumber's Name 44_1 (_ - ' ` ( No.. Street - Location and Legal Description Lot---_._- ___ _ —_-_ _. -._ _ ___ _ _ . Block Date Subdivision_ ._ Street and Number where work is to be performed —No (t Street_ _ ..C _ 4 �. State work to be performed and purpose of building (By Floors). - 2-5_ .� - -. �s�►_ New Building - —_ --- _ . -• - -- --- Remodeling_____ ___ -- _ _ _ Addition_--_ _ __ ____ - - Repairs. _ -_. No. of Stories _ Size Septic Tank__ _ Feet of Drain Tile. Nature of Water Supply. City —Well. __ Type of Tank _ _ _ _ ._Dist. Feet of Tank or Drain Field from Well.. _ __ . Si , of Soakage Pit performed under this permit; and will post or cause to be poster' for inspection on required by the Act. The undersigned agrees to employ only such sub contractor licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. A� I '+ - (Signed)_ ( gnu - -• -, __ Capacity Gass. 6 , work eh pub to be perfo. e Pl..mb tig In.pecto. The undersigned applicant for this building permit does hereby certify that he understands and Loc. is hi.; obligations as an e nployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe in Cpl. ment, 'n 1 I a • om plied with the provisions thereof, and will require similar compliance from all contract° or sub - contractors a loycd {�y hin in the woik to be notice or no ices as are s ef,nit, as are Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personall appeared lumber 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 'acts therein by inn stated are true. My Commission Expires Notary IPublic, 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 UR CAYc: BASIN FLOOR DR AIN D FOU� ' T'NS TOTAL F %TURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN F IELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WE ..L SPRKLR SYSTEM SW IM'G POOL COMM L - ST - CHECK Permit No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Appl_cation 1 1:ereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build ng or other structure herein described. This application is made in comphance 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 th Building Di ' slon 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._ _.__ ..... Street Registered Architect and /or Engineer Employing Plumber's Name 44_1 (_ - ' ` ( No.. Street - Location and Legal Description Lot---_._- ___ _ —_-_ _. -._ _ ___ _ _ . Block Date Subdivision_ ._ Street and Number where work is to be performed —No (t Street_ _ ..C _ 4 �. State work to be performed and purpose of building (By Floors). - 2-5_ .� - -. �s�►_ New Building - —_ --- _ . -• - -- --- Remodeling_____ ___ -- _ _ _ Addition_--_ _ __ ____ - - Repairs. _ -_. No. of Stories _ Size Septic Tank__ _ Feet of Drain Tile. Nature of Water Supply. City —Well. __ Type of Tank _ _ _ _ ._Dist. Feet of Tank or Drain Field from Well.. _ __ . Si , of Soakage Pit performed under this permit; and will post or cause to be poster' for inspection on required by the Act. The undersigned agrees to employ only such sub contractor licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. A� I '+ - (Signed)_ ( gnu - -• -, __ Capacity Gass. 6 , work eh pub to be perfo. e Pl..mb tig In.pecto. The undersigned applicant for this building permit does hereby certify that he understands and Loc. is hi.; obligations as an e nployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pe in Cpl. ment, 'n 1 I a • om plied with the provisions thereof, and will require similar compliance from all contract° or sub - contractors a loycd {�y hin in the woik to be notice or no ices as are s ef,nit, as are Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgn ents, personall appeared lumber 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 'acts therein by inn stated are true. My Commission Expires Notary IPublic, State of Florida — .. -- NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and/or workmanship. BY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contract6r or Builder Legal Description This r Lot IMMBIEWM wr t B Address Buildin of j — } , x-° value of - ..rte-. �,,�1 it granted to the . builder above to construct the strict oomphance , all sad with its cation herefor in p lans, dra stat or that m ay Lave beeed to acid kllitaY a t an y time if the work is not done in bompliance with such ordinances or if the f,, lgol permit Is granted is the undo the contractor or builder aimed egulations pertaining to the work aced hereby whether shown on the ty for work done by his agents, or employees. In consideration of the issuance to me of this permit I wee to pertaining thereto and in strict fo�$pity with the plans, draw, In accepting permit I assuJfr ty for all work done by either / co oR B Subdi- vision Project Amt. of Permit Permit No 1 vi l Owners Name and Address i Q � Amount of Permit $ 6, 0 0 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Registered Architect and /or Engineer // - 1 / b p AJ 3 -49/ Employing Plumber's Name �' Location and Legal Description Lot_ Block Street and Number where work is to be performed —No Street. State work to be performed and purpose of building (By Floors) New Building .___._ — _..---- ••- .- - -.__. Remodeling— _._.._._ —_ Addition -. --_ Size Septic Tank_..- Type of T■nlr Feet of Drain Tile / Di Feet of Tank ar Drain Field from Well Nature of Water Supply: City —WeIL Size of Soakage Pit. (Signed) Subdivision Repairs. No. of Stories. .Gapadty Cale...__._...__ 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 et building during progress of work. © A.' ' % 6 . No. Street.._2y . trove__ ... ^ .r.�`"✓:.aC.. 1 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 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 die Act. The undersigned agrees to employ only such orb- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village Master Plumber. STATE OF FLORIDA, I µ 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 be did sign the same, and that all fads therein by him stated are true. M Gornmission Expires Notary Public, State of Florida NOTE: A re-inspection fee of 61.00 will be made when anoi wiespeotiian de • aeoe spry by bnp cper notice for inspection. or faulty materials and /or walasrmWp. CLOSET. BATH Tuee SNOW[R. LAVA- TORI[. SINK. SLOP SINKS LAUNDRY Tu.. U RINALS CATCH BASIN FLOOR DRAW DRINK NO FOUNT' NS TOTAL FIKTUR[S Corm. LIST CHICK SEPTIC TANK SIWLR CONN. DRAIN FIELD SOAKAGI PIT GR[ASa TRAP SOLAR HEATER OUP WILL SPRKLR. SYST[N SWING POOL Gwent. LIST CHECK Permit No 1 vi l Owners Name and Address i Q � Amount of Permit $ 6, 0 0 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Registered Architect and /or Engineer // - 1 / b p AJ 3 -49/ Employing Plumber's Name �' Location and Legal Description Lot_ Block Street and Number where work is to be performed —No Street. State work to be performed and purpose of building (By Floors) New Building .___._ — _..---- ••- .- - -.__. Remodeling— _._.._._ —_ Addition -. --_ Size Septic Tank_..- Type of T■nlr Feet of Drain Tile / Di Feet of Tank ar Drain Field from Well Nature of Water Supply: City —WeIL Size of Soakage Pit. (Signed) Subdivision Repairs. No. of Stories. .Gapadty Cale...__._...__ 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 et building during progress of work. © A.' ' % 6 . No. Street.._2y . trove__ ... ^ .r.�`"✓:.aC.. 1 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 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 die Act. The undersigned agrees to employ only such orb- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village Master Plumber. STATE OF FLORIDA, I µ 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 be did sign the same, and that all fads therein by him stated are true. M Gornmission Expires Notary Public, State of Florida NOTE: A re-inspection fee of 61.00 will be made when anoi wiespeotiian de • aeoe spry by bnp cper notice for inspection. or faulty materials and /or walasrmWp. - -� CLOUTS BATH Tu // sNOW[R/ RYA. TORI[/ SINKS GLOP SINKS LAUNDRY T // URINAL/ CATCH SA/IN 'LOOM DRAIN DRINKING FOUNT 'N• TOTAL FIKTURE/ CONTR. LIST CHICK + -- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT G TRAP SOLAR HEATER DEEP WELL SPRKLR. SY /TIM SW 1M •01 POOL CONTR. LIST i CHECK Permit No Vo gij, 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 rubes 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 k *a l 1 / MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No Street.. ( . Registered Architect and /or Engineer / / 1) , ' ' t; _ >~m / to P tua 's Nor o � �, Itreet . � � - 2 - / - cT � ._ - .m, s 2 .�. ..� ..... „,... .- /r g e® "/ _' e _ 1 p Loea an Legal Description Lot. L.1 131orlt Off SubdivWon = - - - Street and Number where work is to be performed —No 74 22 t? Street. /.: State work to be performed and purpose of building (By Floors)__ _ _ __ _ New Building-___-._. —_ _ .. - -_ Remodeling- ___._--_. —__ Addition.. ._ Repairs No. of Stories Size Septic Tank.—__ -Type of Teak — _ -- - -- -- _ -__ -, Feet of Drain Tile Dist. Feet of Tank oc Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage Pit Amount of Permit $ (Signed)_ 1 - V'�1F 9 101 -- 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 Supplement, and !apt cnm- piied 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 worlc such public notice or notices es err 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. My Commission Expires (Signed - a� Notary ;Public, State of Florida Gspadty Cale._.- ...___.__ —. - - -- .._ -.._ Muter Plumber. STATE OF FLORIDA, i COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take aclmowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath depose/ and says that he is the —... - -_ ---- .•- . -. - -•- _ _.... —. of the above described construction, that he has carefully read the foregoing appliatbn, and that be 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 whoa snob cis aspaotioa is nude anon -ry by lbnpeopec mike for impaction, or faulty materials and /or workmanship. Date //- .Z -/ Job Address ' {t7/A. 9 S-7- Tax Folio b - .> 7,1 " 4,4 ' " ij - 2.1 D O Legal Description f+'' /fi SVA:W S Owner / Lessee / Tenant jt:c 41 Owner's Address 77 k -11: 5 ; ( • Contracting Co. �' (Z Gif / / //¢CX5 4 3 QualifierJc6E:9 Left)" ss# / State # n(c 4`}' i Municipal # ? �` f ' 1 Compe WORK DESCRIPTION ( 2 6 7/' / 4Uc Signature of owne Date: Notary My Comm ** * PERMIT APPLICATION FOR MIAMI SHORES VILLAGE my to f P apevsk9/ 8 'Ely Service ins No. CC219010 J i4/ 14 Lel a /f2 roe z q- e; - <T S is1.k 6R P 6 / 4)-3 7 - Master Permit #95, Phone / S "f L"— (a C} Address •.. ��^Cle1/0576� (7/4 (A) Phone 7 -VC) - g"'Yd tency # / yi?r7 Ins.Co. X`V� Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL ' " 41ECHANICAL ROOFING PAVING FENCE SIGN ( Square Ft. Estimated Cost(value) L` . 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. -ove -named contractor to do the work stated. Si rt r Owner- Builder Date: otary as fo` 'ice o ff' Owner- Builder My Commiss :•fires: * * * * * * * * * * FEES: PERMIT RADON C.C.F. NOTARY TOTAL DUE APPROVED: Fire Other Zoning Building Electrical Mechanical Plumbing ��' /5t