ELECTRICALDate �3 �/ 9g Job Address
a 7
Owner / Lessee / Tenant y €!f!G4../ 704„,1
Legal Description /Oki" /l
Owner's Address /0 A/I 9 1' 5 T
Contracting Co. / , i v)7 leAS/.
Qualifier /4%3w J„ �
State #4
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): B ILDING
WORK DESCRIPTION / �✓
4
Square Ft. Estimated Cost(value)
1gn
Dat
** *
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Municipal #
e of owner and /•r Condo President
y 95
Notary as to er p < <�,
: , -
My Commission Expire
* * *
OFFICIAL SEAL
JUL'0 Rnai FR
sp eStentisitontExplres
June 4, 1996
*.lFoFFestt: Comm. No. CC 205953
* *
APPROVED: Fire
Zoning Building
SS# / Phone
Tax Folio/ / 5740 / � 09d? 5
7n .s .ge'/
Master Permit ii , / //G J
Phone zr
Address
f9.5-,
Competency # Ins.Co.
L PLUMBING MECHANICAL 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
a orize the above -named contractor to do the work stated.
* * *
Signature
Date:
9J • '. . ~•
Notary as to Co � dr ' . 9- i$t}4iires
My Co E 361) 1.. 1 ;,1"1"."" June 4, 1996
d o p
*CP. of FY' e `
*
of Contr for or,Mwner- Builder
*
FEES: PERMIT 0 RADON C.C.F. �7 ` NOTARY TOTAL DUE 4O( 5)
Other
*
Mechanical Plumbing Engineering
Comm. No. CC 205953
*
EAL
**
Permit No._
STATE OF FLORIDA, l
72-
COUNTY OF DADE.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date._ er
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.— __ _ Street --
Registered Architect and /or Engineer.
Employing Electrician's Name_-_ —.___ c,' ° f / _Street 9—
Location and Legal Description Lot f o et" / v Block_- __- -____ - Subdivision_ 1- - -_II .S_
Street and Number where work is to be performed —No i d e, f r - -Street
State work to be performed and purpose of building (By Floors) ..
New Building Remodeling Addition Repairs
Service Overhead Size Feeders Conduit Main Sw. _Amps — _________Main Fuses .Amps
Underground
Type of Installation—Conduit __________ ____Tubing B.X.L. Metal Moulding
Amount of Permit ( Signed)
Electrical 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 complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the
work to be performed under this permit; and will post or cause to be p osted 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) C .ivr�✓
Master Electrician.
No. of Stories
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, and 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.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
�
NO. LAMPS
N
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL.
CONTR.
LIST
,yv
2.-
Y
1
/
/
/
3 •
•
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
f SERVICE
I PERM.
MOTORS
0-1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/
/
I /
.
CHECK
Permit No._
STATE OF FLORIDA, l
72-
COUNTY OF DADE.
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date._ er
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.— __ _ Street --
Registered Architect and /or Engineer.
Employing Electrician's Name_-_ —.___ c,' ° f / _Street 9—
Location and Legal Description Lot f o et" / v Block_- __- -____ - Subdivision_ 1- - -_II .S_
Street and Number where work is to be performed —No i d e, f r - -Street
State work to be performed and purpose of building (By Floors) ..
New Building Remodeling Addition Repairs
Service Overhead Size Feeders Conduit Main Sw. _Amps — _________Main Fuses .Amps
Underground
Type of Installation—Conduit __________ ____Tubing B.X.L. Metal Moulding
Amount of Permit ( Signed)
Electrical 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 complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the
work to be performed under this permit; and will post or cause to be p osted 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) C .ivr�✓
Master Electrician.
No. of Stories
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, and 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
Owner's Name and Address_____—____
Registered Architect and /or Engineer ___L_
New Building
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
}
ss.
M IAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fof 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.
Remodeling_
Date
--- ---------------------- ------ --- ------------ ----- ---- ----- --------- --- ---- - -- - -- ---
E __Street_ -
Employing Electrician's Name L �''�!►�'K21,1..__ No.___ 2a y
7
/ O ll / � /� [ Subdivision__ __�
performed —No.
Street and Number where work is to be / L ?
__ __ - _• -- __ - � , Street- -- _-- _ .�__ -- _ - _
State work to be performed and purpose of building (By Floois)_____lr �l4
Location and Legal Description Lot____! /o__ L_L____ _ _ Block
_Addition_______ ____________________Repairs
_Street__
Vx-f
No. of Stories_ _____
that he
Service Overhead
nderground Size Feeders_______________ Con Sw.��__ _______Am. • __Main Fuses— Amps
Type of Installation—Conduit_______i_Tubing
..r trAr Ir. gap •
( __
Ele : 'cal pector.
derstands and accepts his obligations as . . employer of
The undersigned app t for this building permit does hereby certif
labor under the Florida Workmen's Compensation Act, being Section 5966, _ : .i ed General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to
licensed by Miami Shores Village.
of Florida Permanent ' upplement, and
sub - contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
Master Electrician.
Before me, the undersigned authority, a notary public, duly a uthorized 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, and 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
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.
Notary Public, State of Florida
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
N. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
(SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No
Owner's Name and Address_____—____
Registered Architect and /or Engineer ___L_
New Building
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE.
}
ss.
M IAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted fof 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.
Remodeling_
Date
--- ---------------------- ------ --- ------------ ----- ---- ----- --------- --- ---- - -- - -- ---
E __Street_ -
Employing Electrician's Name L �''�!►�'K21,1..__ No.___ 2a y
7
/ O ll / � /� [ Subdivision__ __�
performed —No.
Street and Number where work is to be / L ?
__ __ - _• -- __ - � , Street- -- _-- _ .�__ -- _ - _
State work to be performed and purpose of building (By Floois)_____lr �l4
Location and Legal Description Lot____! /o__ L_L____ _ _ Block
_Addition_______ ____________________Repairs
_Street__
Vx-f
No. of Stories_ _____
that he
Service Overhead
nderground Size Feeders_______________ Con Sw.��__ _______Am. • __Main Fuses— Amps
Type of Installation—Conduit_______i_Tubing
..r trAr Ir. gap •
( __
Ele : 'cal pector.
derstands and accepts his obligations as . . employer of
The undersigned app t for this building permit does hereby certif
labor under the Florida Workmen's Compensation Act, being Section 5966, _ : .i ed General Laws
has complied with the provisions thereof, and will require similar compliance from all contractors or
work to be performed under this permit; and will post or cause to be posted for inspection on the site
as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to
licensed by Miami Shores Village.
of Florida Permanent ' upplement, and
sub - contractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
Master Electrician.
Before me, the undersigned authority, a notary public, duly a uthorized 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, and 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
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.
Notary Public, State of Florida
Permit No fr
a
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date tl,.
6 /9a."
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. /� G
Owner's Name and Address r� — /��T7� �.�, No / Streeo�l� ! 8 s�
Registered Architect and /or En i eer ,, yy/
Employing Electrician's Name.EL "n c r �a� �Ll" a No.. . sx) Street.. 16 .,
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No .e✓Q
Street Je/— gig ,l
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
STATE OF FLORIDA,
COUNTY OF DADE. Ij ss'
Amount of Permit S (Signed)
lectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o giltions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida mancnt Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-cont rs 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 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)
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, and 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 rc'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.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIG.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
H ATER
STRIP
HEATER
TOTAL
CONTR.
LIST
a
Z
Z
z
9,
CHECK
y
IV 1
111"'
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
I•S HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No fr
a
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date tl,.
6 /9a."
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. /� G
Owner's Name and Address r� — /��T7� �.�, No / Streeo�l� ! 8 s�
Registered Architect and /or En i eer ,, yy/
Employing Electrician's Name.EL "n c r �a� �Ll" a No.. . sx) Street.. 16 .,
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No .e✓Q
Street Je/— gig ,l
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
STATE OF FLORIDA,
COUNTY OF DADE. Ij ss'
Amount of Permit S (Signed)
lectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his o giltions as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida mancnt Supplement, and
has complied with the provisions thereof, and will require similar compliance from all contractors or sub-cont rs 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 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)
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, and 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 rc'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.
•
C. r
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No Date / /IA *4 ""
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 lam' 5'6 L • No /D Street y V,
Registered Architect and /or Engineer
Employing Electrician's Name e 7 A . 46-E - r •
Location and Legal Description Lot
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
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation -- Conduit Tubing B.X.L Metal Moulding
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and acct
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws o
has complied with the provisions thereof, and will require similar compliance from all contractors or s
work to be performed under this permit; and will post or cause to be posted for inspection on the site of
as are required by the Act. The undersigned agrees to employ only such subcontractors, on ; ork to be
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. I "'
/ e2
My Commission Expires
NOTE: A re-inspection fee of $1.00 will be made when
materials and /or workmanship.
(Signed)
(Signed).
No 1'1' 4°- N Street
Block Subdivision
Street 246 9 9"
•
4t/52w:1-1- ?/ 7
Repairs No. of Stories
Electrical Inspector.
s obligations as an employer of
rida Permanent Supplement, and
•contractors employed by him in the
the work such public notice or notices
performed under this permit, as are
b
Master Electrician.
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, and 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
such re-inspection is made necessary by improper notice for inspection, or faulty
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T's
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
H EATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
M OTORS
0.1 HP
M OTORS
1.5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Permit No Date / /IA *4 ""
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 lam' 5'6 L • No /D Street y V,
Registered Architect and /or Engineer
Employing Electrician's Name e 7 A . 46-E - r •
Location and Legal Description Lot
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
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation -- Conduit Tubing B.X.L Metal Moulding
Amount of Permit $
The undersigned applicant for this building permit does hereby certify that he understands and acct
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws o
has complied with the provisions thereof, and will require similar compliance from all contractors or s
work to be performed under this permit; and will post or cause to be posted for inspection on the site of
as are required by the Act. The undersigned agrees to employ only such subcontractors, on ; ork to be
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. I "'
/ e2
My Commission Expires
NOTE: A re-inspection fee of $1.00 will be made when
materials and /or workmanship.
(Signed)
(Signed).
No 1'1' 4°- N Street
Block Subdivision
Street 246 9 9"
•
4t/52w:1-1- ?/ 7
Repairs No. of Stories
Electrical Inspector.
s obligations as an employer of
rida Permanent Supplement, and
•contractors employed by him in the
the work such public notice or notices
performed under this permit, as are
b
Master Electrician.
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, and 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
such re-inspection is made necessary by improper notice for inspection, or faulty
„Aez3v,./ 4 ‘€4,
IOU S'O Ai Lc_ o .