SCREEN PORCH/ OCCUPANCYOWNER'S NAME
Dr. & Mrs. John Simione
PRESENT ADDRESS
LICENSE NO.
PHONE Np.
- '
JOB LOCATION (ST. OR AVE.)
1059 N.E. 98th Street
LOT
14
BLOCK
179
SUBDIVISION r
See. 8
GENERAL CONTRACTOR
owner
i
ADDRESS
PHONE NO.
LICENSE NO.
15692
BUILDING PERMIT NO.
1 -29 -54
DATE
24.00
PERMIT FEE S
BUILDER'S BOND
1638
NO. DATE
ZONE REQUIREMENTS CU. FT.
26,463
PLAN CUBE CU. FT.
20,000
EST. COST S
DRAWINGS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY
DATE
NEW CONSTRUCTION
TYPE
CBS
STORIES ROOF CONSTRUCTION
1- tile
INTERIOR CONSTRUCTION
terrazzo floors, plaster wall
REPAIRS
and ceili�p ee,
DESCR IPTION "C
garage-living room-kitchen-den-Fla. room -2 bdrm. -2 baths
ALTERATION
DESCRIPTION
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SUBMITTED TO VILLAGE COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO. `�, 2 30 2 —
ISSUED) / / J/
BY 14 44 )
TO VII`(
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
-1 I NSPECTIONS:,.;
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
' =,-/),-, `/
I,k.r ■
FEE
TEMPORARY SERVICE
'
BEAMS & LINTELS
2 -, ?t.. f„
t I
A
�4 =C;';;
o q
$
FRAMING
$
SOLAR HEATER
$
FIXTURES
��� -".-
/
$
S
Sv --ham ' 0. ,
Jn_,e.n d. ii.1
/
/� l�Q�
S
FINAL v
Sar. - 4 '' �
ci
BY
RE- INSPECT
BY
RE- INSPECT
CLEAN -UP
cG
It
ROUGHING
CONTRACTOR�� .�/} t �S—^;. ^� /�
PHONE
PERMIT NO. / t l .-/-.:
DATE C 'J' , , N J
FEE , 3 C
U
NEW BLDG. I ALTERATION I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
'
$
SEPTIC TANK ' .AA 's
1 ° ")
RANGE CONN.
S c c ��J
SEWER
$
MOTORS
$
SOLAR HEATER
$
FIXTURES
S
GAS
$
S
Sv --ham ' 0. ,
Jn_,e.n d. ii.1
/
/� l�Q�
S
1'"i i :�J. 9 F�,..
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
" y e ti
ROUGHING
;: : '
GAS
H. W. HEATER CONN
SEWER
•
RANGE CONN.
SEPTIC TANK
v`6' e� f,
gl l N'. o
SOLAR HEATER
&FINAL
rrn iX FIXTURES
I
FIXTURES
5'a5
•
CONTRACTOR -f c., /
PHONE
A
FEE $ �'s�• Y..�. �
,
/
PERMIT NO. /5 - T3 ,g DATE ` ` c } J, e) :6
NEW BLDG. 1 ALTERATION T ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
J5 7 J ` —^L£
- , ::„s, (- ' , ::„s,
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
;: : '
H. W. HEATER CONN
RANGE CONN.
&FINAL
rrn iX FIXTURES
I
9
7?
�
id o'J�
BUILDING INSPECTIONS
PLUMBENG PERMITS & INSPECTIONS
ELECTRICAL & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE Jr �� % • f "8f � ' if/7 .�1
dd I
N9 1972
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Owner, Agent or Tenant of Building t . .
Lot / Block
Street Address ' 9
Approved use by occupancy
Miami Shores Village,
N.
ill Subdivision
�n .�. c g
'e Ct ,.�.,
I'D , x 3
Fla., S -0/- 5q.
a
Remarks.
This Certificate of Occupancy is issued to the above named
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or r odeling of buildin :s or t ctures.
A
BUIL
ING D VISION
Application is hereby made for the approval of the det ,. iled statemen of the plans and specifications herewith submitted for the build-
ing or o h. -ructure her i described This isi licatic is made in compliance and con o'rn ty w.th the Building Ordinance of Mia ii
Shores Vi1Iae or da, and all pro isions of the Laws ( f the State of I krid. all o d nances if Mi m Shores Village and all rules and
regu'a of the Building Div . i of .lam Shoi iilage 1- '1 ,e -o. ipl.ed with, whether herein specified or not. A copy of approved
plans and specificati n must be ken • at building durin progress of tl.e wcrk.
Owner' Name and Address__
Registered Architect and/or Engineer _
Name nd address of licensed contractor
Location and legal description of lot to be builyi:
Lot
Subdivision
Street and Number where work is to be done 41
State work to be done and purpose of building (by floors)
New Building 1,7 Remodeling._
To be constructed of Kind of foundation
Estimated ^. -,tal cost of improvements $__ C)
Zone ^ubage required_ __.
Distance to next nearest building _
Maximum live load to be borne by each floor _ . _____
hereby submit all the plans and spechications for said building. All notices with reference
be sent to .
The unde signed appli ant for th's building permit does hereby certify Clat he understands and accepts his ..bligations as an employer
of 1 bor under he Florida Workmen's Compensation Act being S. -tion 5966 Col p led Gen al Laws of Florida P r anen Sipple nent,
and h s compl ed w;th he prov• :ions thereof, and will require similar comp lance from all contractors or sub-contractors cmplo •ed by him
in the wo k to be p rf - med under th s pern it and ill post or cause to be posted for inspection on the site of the work su :h public noti. e
or •oti(es as are requir d by the Act. The u. d.r ign .d agrees to employ only such abcontr. etors, on work to be perform d der this
permit as are licensed by M am, Shores ge.
Remarks
Permit No
STATE OF FLORIDA,
COUNTY OF DADE. Ss '
Disapproved __
(Signed) ____
Chairman
Membe
Member
Council Approved
•••••
MIAMI SHORES VILLAGE
BUILDIN INSPECTION DEPARTMEN
APPLICATION FOR BUILDING PERMIT
Block. /
Building Inspector
'4 -(vv■.41
•
Before me, the undersigned authority, a notary public, duly authorized to adm.nister oaths ...nd take acknowledgments, personally pp-
peared _
and who, being by me first d. ly sworn, upon oath deprres and says that he is the
of th abov. de .t. ibed • istruction t h has c eially r ad the foregoing application, and that he did sign the same, and that all facts
therein by him stated are tr ie.
PLANNING BOARD
( Signed)
,
Date
VVNA04,41NA.S.... No Street
. Date
Read, Sworn to and Subscribed before me.
Notary Public State of Florida
My Com:nission Expires_
DATE
Member
Member
Member
Disapproved
6
and for no other purpose.
Addition.... _____ _ Repairs.
,
No. of Stories _
___ Roof Cov 7%7(.00....
.P 0
Amount c E Permit $--
Plan Cubage__
__Size of Building Lot
to the building and its construction may
■
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application Ift..r approval llis been obtained, from
the Planr ng Board
A re-inspection fee of $1.00 will be charged when such re-inspection is nu ie necessary by improper notice for inspel.t fa. ity
materials and/or workmanship.
OWNER'S NAME
GOTTIIEB & 00.
PRESENT ADDRESS
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.) LOT
1113 NI 98th St.-
BLOCK
SUBDIVISION
sew. B
_ $
GENERAL CONTRACTOR ADDRESS
GOTTISEil & COB1PANY i i c 1506 ST 3rd Ave
PHONE NO.
LICENSE NO.
BUILDING PERMIT NO. 10266
C
DATE 111 - 50
PERMIT FEE $ 19.00
�� B g U C ILDER'S BOND
NO. 11135. DATE 11 -15_50
EST. COST $ 1.5,000.
ZONE t R EQUIREMENTS 20,000 CU. FT.
PLAN CUBE`' 9 CU-FT.
DRAWII4GS, SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: PG
DATE
11 -15.50
NEW CONSTRUCTION
TYPE
t7�p
0AB
STORIES
1
j, ROOF CONSTRUCTION
the
INTERIOR CONSTRUCTION
oak aloora -plras walla
REPAIRS
DESCR IPTION
Z
ALTERATION
DESCRi PTION
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SUBMITTED TO VILLAGE COUNCIL
REMARKS
1 L /
CERTIFICATE OF OCCUPANCY NO. / 4�
1r l(^I,
ISSUED 3- - .3I --S4 BY /� - JI
,
TO ( v n `'v
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
//"..5f <1.15
FEE
�.� ® °;
$
BEAMS & LINTELS
1.11
5
SEWER
FRAMING
g-.7 7- On,
$
GAS
$
$
INSPECTIONS
FINAL
.—,� ..
;A.- .
BY
RE- INSPECT
BY
ROUGHING
CLEAN -UP
..
f
GAS
CONTRACTOR a sss. • yrr� TOCM
PHONE
'A
PERMIT NO. 10374 DATE ��50
FEE $ 9.50
BLDG. f I ALTERATION ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
SEPTIC TANK
5
SEWER
S
SOLAR HEATER
$
GAS
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
/ a�6 —�y (/
GAS
/4 -44-c°
1.2
SEWER
/
SEPTIC TANK
/Z" - ' 6
$j
�° f
SOLAR HEATER
FIXTURES
3 - t ..)_ 4.,
L
CONTRACTOR STARK ELECTiR IC
PHONE
PERMIT NO. k 9 3 DATE 12 -2150
FEE 5 11.50
NEW BLDG. 1 ALTERATION I ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
$
-. INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
/4 -44-c°
1.2
H. W. HEATER CONN
/
RANGE CONN.
FIXTURES & FINAL 3- 4 -..17
,I
P,4'
BUILDING INSPECTIONS
PLUMBING PERMITS & INSPECTIONS
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE 3 - 7 - 5 B 7145
N9 1423
Owner, Agent or
Lot
Street Address
Approved use by
CERTIFICATE OF OCCUPANCY
4, its 7 4
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Miami Shores Village, Fla , 3 ' 4 V 2 -
Tenant of Building * W
Block 1 7 9 Subdivision
/ I I mil - G % 5 A ,
occupancy
1
Remarks.
This Certificate of Occupancy is issued to the above named a-.
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93;94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildings or structures.
BUILDING DIVISION
ADDRESS 1113 N. E. 98th Street
Lot 17, Block 179
LEGAL Miami Shores Sec 8
RECORD GARBAGE TAX
PAID BY
YEAR
ANNUAL TAX
PERIOD USED
AMOUNT PAID
DATE PAID
RECEIPT
NUMBER
r ..i
t_.
„,,.
ADDRESS 1113 N. E. 98th Street
Lot 17, Block 179
LEGAL Miami Shores Sec 8
RECORD GARBAGE TAX
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 ecified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address!
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
1"2 Block 1
tE
Lot
Street and Number where work is to be done_
I
b floors
State work to be done and purpose of building (by )
To be constructed of__— ��.� _
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
MIAMI SHARES VILLAGE
tea BUILDING INSPECTION DEPARTMENT
atzto
Date
Street
Subdivision__.
- - -'
____ _,7
New Building ___ Remodeling "on Repairs
Kind g f fcation _ 4 ' ej
Estimated Total cost of impr4Yements
Zone cubage required
Distance to next nearest buildin S'ze of Building Lot
Maximum live load to be borne by each floor
CP — — — -- — _Plan Cubage CZ 7
ount of Permit $ 1
Notary Public, State of Florida
ev_ g .moo
and for no other purpose.
No. of Stories__
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may,
be sent to
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 posted for i ection o the site of the ork such pub 'c notice
permit, as are licensed by Miami Shores Village.
or notices as are required by the Act. The undersigned agrees to employ only such f tractore on we to perfo ed lder this
Remarks (Signed). . ,,,
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
Permit No Date Read, Sworn to and Subscribed before me.
Disapproved Date
( Signed)
Building Inspector My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of $1.00 will be charged wherf such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.„
G2.0 g 42.42 2Gao C:Zo.D
El,c1.00 V-I.L21P/ 11 5
ab°5 s,
r -
LOPS '34' _sp
I
=
011
1 _ 2,0 s
ti,q0QFz 2. 65
q,0
DG - to
4--
2 Nit r5taci_- 28, \La
anAGE 1 .• . ___■ 1 000
!_e_t_qttqci
1
.
,
--,--
Ict .
V
4...
.
-..
1
ep-
(4,52
3 I 1 83
t S5
_4-
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ab°5 s,
r -
LOPS '34' _sp
I
=
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1 _ 2,0 s
ti,q0QFz 2. 65
q,0
DG - to
4--
2 Nit r5taci_- 28, \La
anAGE 1 .• . ___■ 1 000
!_e_t_qttqci
OWNER'S NAME
George Hines
PRESENT ADDRESS
LICENSE NO.
PHONE NO.
i L/- /7V
JOB LOCATION (ST. OR AVE.)
1113 N,E. 98th Street
LOT
BLOCK
SUBDIVISION I
GENERAL CONTRACTOR
owner— builder
ADDRESS
PHONE NO.
LICENSE NO.
BUILDING PERMIT NO. 1/.20
�
DATE 3 -22 — " J
PERMIT FEE $ 6
BUILDER'S BOND
NO. DATE
ZONE REQUIREMENTS CU. FT.
PLAN CUBE 2,780 CU. FT.
EST. COST S 1100
DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY:
DATE
NEW CONSTRUCTION
TYPE
STORIES
ROOF CONSTRUCTION
INTERIOR CONSTRUCTION
REPAIRS
DESCR IPTION
screen porch
ALTERATION
DESCRIPTION
ADDITION
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
SUBMITTED TO VILLAGE COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO. ill
ISSUED
'
BY Z.
TO
BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE
INSPECTIONS
PHONE
BY
RE- INSPECT
BY
RE- INSPECT
BY
FOUNDATION
/) DATE
ay, ° ,T �i „ °g
, S y r
FEE
TEMPORARY SERVICE
$
BEAMS & LINTELS
- /':J
1% ' C '�'
$
$
SEWER
FRAMING
$
SOLAR HEATER
$
$
GAS
$
$
$
$
FINAL
//ii
�/QYy
�
4d2)
< - '' , � �,C}r/
��
RE- INSPECT
BY
CLEAN -UP
to (fi) --S _
1..1
ROUGHING
CONTRACTOR
PHONE
PERMIT NO. I DATE
FEE $
NEW BLDG. 1 ALTERATION
ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
$
SEPTIC TANK
$
$
SEWER
$
$
SOLAR HEATER
$
$
GAS
$
$
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
ROUGHING
GAS
H. W. HEATER CONN
SEWER
RANGE CONN.
SEPTIC TANK
SOLAR HEATER
` FIXTURES & FINAL
FIXTURES
„ p
,
CONTRACTOR 6j - e .1,-----,
PHONE
PERMIT NO. - 1/ ) G //' 1 DATE - L-W. -,
FEE $ OS
NEW BLDG. 1 ALTERATION ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
$
$
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
` FIXTURES & FINAL
„ p
,
BUILDING INSPECTIONS
PLUMBING PERMITS & INSPECTIONS
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
�' r `l ;�
N9 197
Owner, Agent or Tenant of Building
Lot
Street Address
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Approved use by occupancy
Remarks
Miami Shores Village, Florida,
Block Sub vision
111 r) - ►
�\ J ct...D-OW •
This Certificate of Occupancy is issued to the above named
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or modeling of buildings or structures.
1 ) i Q Z b w
I - _I 0 v ,3 BUILDING DIVISION
i
N9 1423
Street Address
Approved use by occupancy
Remarks.
CERTIFICATE OF OCCUPANCY
MIAMI SHORES VILLAGE, FLORIDA
BUILDING DIVISION
Miami Shores Village, Fla , 3 - r ` �►`
Owner, Agent or Tenant of Building ' '-
Lot
1 1 Block 17 (f Subdivision
This Certificate of Occupancy is issued to the above named "‘00
for building at above named location only upon the express provision that the applicant will
abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known se the
Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to
the erection, construction, alteration or remodeling of buildings or structures.
C I , "�..
a E I / it i . L �,,� .... BUILDING DIVISION
_______J
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing 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 the work.
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on:
Lot Block Subdivision
/ /.f 3
Street and Number where work is to be done
State work to be done and purpose of building (by floors)
STATE OF FLORIDA,
COUNTY OF DADE. ss
Disapproved _ Dat
(Signed)
Buil Inspector
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
/.
Remarks (Sign
Date
No / 3
New Building Remodeling
To be constructed of Kind of foundation ' Q.IM, `!iy►.
Estimated Total cost of improvements $ t__(__Q__° mount of Permit $
Zone cubage required Cubage
Distance to next nearest building.. r +' Size of Building Lot
t
o[ —
Street
I
9.�
and for no other purpose.
ddition Repairs
Roof Covering
No. of Stories
Guns
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
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 posted for inspection on the site of the ork such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontra s, on work to . . ormed under this
permit, as are licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
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.
�as - s Permit No 1 4 ?..0 Date 3• Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.