ELECTRICALMIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date 9 I/ 2 -VO 3 Time
Type Insp'n ¢ /f'14/ G /eC •
Permit No. Zd D -- S `�
(a d ` , ;$
Name
Address /075 "VE • 99 57
Company
Phone # 365 - 2 & - 75/6
For Inspector: e �- 1� /zs /Name & Date
Approved
Correction
Re- Insp'n Fee
Lam"
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT 6 ,0\�'�
305- 795- 2204
Building Inspection Request
Date 9/z5 3 Time
TypeInsp'n ,9/k2Q/ E kC•
Permit No. 200 -- S' `10
Name C ,nP ,,
Address /075- ve • 99 sr
Compan
Phone # 30S - 26 - 7 5 76
For Inspector: e L 7 /Z-C lame & Date
Approved 171
Correction ❑ �� ���"
Re- Insp'n Fee ❑
Date
Type Insp'n
Permit No.
Name
Address /0
Compan
Phone #
For Insp
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Time
lJ - °
be) c)- 'sF
ctor: (J`�
Approved ? LK
Correction
Re- Insp'n Fee
Name .,
❑ / -/�,do
o
76 Am
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
S Time
Type Insp'n t""1ra 1 2f
Permit No. E\
Name N e i RA3,1
Address \O S. 1"E i "l S
3\6
Company
Phone #
For Inspector: r 12 Name
Approved
Correction L�J
Re- Insp'n Fee 1!Y
bQ
4 81-1 -
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
// 2—
(Signed)
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. 77;9
Owner's Name and Address 0 W
Registered Architect and /or Engineer
Employing Electrician's Name PEW Etc EE EC TR CC L Nr • No
Location and Legal Description Lot
Street and Number where work is to be performed— No...... /D ' 75--
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Date
No / S Street ! `r ' F' / S / t
26 6 i' S• L Street S S
Block Subdivision
Street ..l 9 6
/' - lc 1 2
Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground p p
Type of Installation — Conduit Tubing.. B.X.L .Metal Moulding
C. eY c F p' E 71v0 )tEs to R ,-: MO 4 <4 p. 18 Pei
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 posted for inspection on the site of the w• .. blic 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.
STATE OF FLORIDA, }
COUNTY OF DADE. 88.
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
FI %TURFS
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
/9„.,
47 - 04
CONTR.
UST
CHECK
4,00
•Oc
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1 -5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
CHECK
Permit No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
// 2—
(Signed)
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. 77;9
Owner's Name and Address 0 W
Registered Architect and /or Engineer
Employing Electrician's Name PEW Etc EE EC TR CC L Nr • No
Location and Legal Description Lot
Street and Number where work is to be performed— No...... /D ' 75--
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition
Date
No / S Street ! `r ' F' / S / t
26 6 i' S• L Street S S
Block Subdivision
Street ..l 9 6
/' - lc 1 2
Repairs No. of Stories
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground p p
Type of Installation — Conduit Tubing.. B.X.L .Metal Moulding
C. eY c F p' E 71v0 )tEs to R ,-: MO 4 <4 p. 18 Pei
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 posted for inspection on the site of the w• .. blic 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.
STATE OF FLORIDA, }
COUNTY OF DADE. 88.
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.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
PERMIT N? 5535
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description — C' B1
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
CONTRACTOR OR BUILDER
Signed.
DATE 195
Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Value of
Project
$
Amount of "t e„
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes rgsponsibility for work
done by his agents, servants or employees. '
Jior
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
Permit No..c ! s
Owner's Name and Address
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
MIAMI 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 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.
k R i fA c7,4 No c 7 I
j G
No 7 Sr Street /
eV fi a /. -Y1, p-.
Street
_ lock Subdivision
� � < Street p I7 '.57
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.. ..i.e' 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 subcontractors 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 subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 'l
COUNTY OF DADE. I
SS.
(Signed)
lectrician.
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 facto
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
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
ACE
HATER
STRIP
HEATER
TOTAL
CONTR.
LIST
CHECK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
I i /�
/'
CHECK
Permit No..c ! s
Owner's Name and Address
Registered Architect and /or Engineer
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
MIAMI 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 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.
k R i fA c7,4 No c 7 I
j G
No 7 Sr Street /
eV fi a /. -Y1, p-.
Street
_ lock Subdivision
� � < Street p I7 '.57
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.. ..i.e' 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 subcontractors 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 subcontractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA, 'l
COUNTY OF DADE. I
SS.
(Signed)
lectrician.
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 facto
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.,c
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. r )
Owner's Name and Address
Registered Architect and /or Engine f.
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
-
Overhead
Service Li Site Feeders Conduit.e 2i Main Sw
Type of Installation— Conduit Tubing Le" B.X.L
No Or Street
No d/ (' ' Street
Block / ,. g
(Signed)
Street
Amount of Permit $ "1' `f (Si
The undersigned applicant for this building permit does hereby certify that he understands a a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled 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 subcontractors, on work to
licensed by Miami Shores Village.
Date
Subdivision
State work to be performed and purpose of building (By Floors)
New Building v Remodeling Addition Repairs No. of Stories
0 0 Amps Main Fuses Amps
Metal Moulding
Electrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
subcontractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
•
Master ` lecian.
STATE OF FLORIDA,
COUNTY OF DADE: I "''
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.
y Commission Expires Notary Public, State of Florida
: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
m rials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE•P'T'S
FIXTURES
NO. LAMPS
REPRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL.
CONTR.
®
/
�� %
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
0.1 HP
MOTORS
1.5 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
LIST
V
/. •
CHECK
Permit No.,c
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. r )
Owner's Name and Address
Registered Architect and /or Engine f.
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
-
Overhead
Service Li Site Feeders Conduit.e 2i Main Sw
Type of Installation— Conduit Tubing Le" B.X.L
No Or Street
No d/ (' ' Street
Block / ,. g
(Signed)
Street
Amount of Permit $ "1' `f (Si
The undersigned applicant for this building permit does hereby certify that he understands a a
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled 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 subcontractors, on work to
licensed by Miami Shores Village.
Date
Subdivision
State work to be performed and purpose of building (By Floors)
New Building v Remodeling Addition Repairs No. of Stories
0 0 Amps Main Fuses Amps
Metal Moulding
Electrical Inspector.
ccepts his obligations as an employer of
of Florida Permanent Supplement, and
subcontractors employed by him in the
of the work such public notice or notices
be performed under this permit, as are
•
Master ` lecian.
STATE OF FLORIDA,
COUNTY OF DADE: I "''
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.
y Commission Expires Notary Public, State of Florida
: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty
m rials and /or workmanship.
Permit No
Application is hereby de 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.
Owner's Name and Address
Registered Architect and /or Enginee . j
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building L"
APPLICATION FOR ELECTRICAL PERMIT
MIAMI SHORES VILLAGE
Amount of Permit $
ELECTRICAL INSPECTION DEPARTMENT
No
No Va,o Street.
Block /7
/G 7
(Signed).
Date 2 ' 4 1/- �^c
X10 e Street 2/'
Subdivision
Street... /<7' (c )
ti J4
to
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs No. of Stories
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
(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 subcontractors 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.
aster Electrician.
STATE OF FLORIDA,
COUNTY OF DADE: Jj
SS.
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
NO : 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'7'8
FIXTURES
NO. LAMPS
REFRIO.
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
1.8 HP
NEON
TRANS.
RADIO
TOTAL
CONTR.
IET
LIST
CHECK
Permit No
Application is hereby de 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.
Owner's Name and Address
Registered Architect and /or Enginee . j
Employing Electrician's Name
Location and Legal Description Lot
Street and Number where work is to be performed —No
New Building L"
APPLICATION FOR ELECTRICAL PERMIT
MIAMI SHORES VILLAGE
Amount of Permit $
ELECTRICAL INSPECTION DEPARTMENT
No
No Va,o Street.
Block /7
/G 7
(Signed).
Date 2 ' 4 1/- �^c
X10 e Street 2/'
Subdivision
Street... /<7' (c )
ti J4
to
State work to be performed and purpose of building (By Floors)
Remodeling Addition Repairs No. of Stories
Service Overhead Site Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation— Conduit Tubing B.X.L Metal Moulding
(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 subcontractors 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.
aster Electrician.
STATE OF FLORIDA,
COUNTY OF DADE: Jj
SS.
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
NO : 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.