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40 NE 98 St (9)Date � Job Address WO NO" O" q D ✓ Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant al 2, Master Permit # � a 3 'r t/ r V 4 c f Owners Address q ' 's�[� Phone '` %f� G� 16 Contracting Co. Qualifier 1) PT L�Jij fl SS# / Phone %4X State # Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDIN ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN /C /a wbea - WORK DESCRIPTION W i te a Square Ft. Estimated Cost (value) 0 WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S cons 1 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Arn z a hi Ce Address ` / /mil A151Q a 9/ O M # AVIT: I certify that all the foregoing information is accurate and that all work will be done in • 010116 e 0o President��.� �! d zoning. Furthermore, I i . - r e the above -named contractor to do the work Signature • r er d/or Condo President a ate Signature of Notary as to Owner and/or Con My Commission E.n • FEES: PERMIT APPROVED: Zoning Mechanical e stY t ,1 VICTOR M. SIERRA MY COMMISSION # CC 801672 EXPIRES: 01/122003 @ i fOF10 - 1- 800 -3- NOTARY Fla. Notary Services & Bonding Co e90 RADON Competency # Ins. Co. 0/ 0/ • • /. ‘n .ctor li t OF 1` -Q 1 - 800 -3- NOTARY VICTOR M. SIERRA MY COMMISSION # CC 801672 EXPIRES: 01/12/2003 Fla. Notary Services & Banding Co. uilder Notary as to Contractor or Owner- My Commission Ex, . NOTARY ' (7 er- Builder ce with all applicable laws regulating '244/ Date BOND TOTAL DUE 6 "1 Building Electrical �/l ✓ .7Z /./ C.C.F. Plumbing Structural Engineer ITEM 3ATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 31DET LIGHT CURETS CENTRAL HEATING )ISHWASHER RECEPTACLES A/C (WIND) )ISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN MPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/IAETER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS .AVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS JIOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 If HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEb8LIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 If FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS RATER CLOSET MOTCRS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION RATER SUPPLY TO: AIR CONDITIONERS ' C A/C UNIT STRIP HEATER t 1 O Kv.I `'' FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS I HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES EWER CONNECTIONS SIGN TRANSFORMERS _ JTILITY -SEWER SIGN TIME CLOCK JTILITY -WATER • FIXTURES ;EPTIC TANK ANTENNA 1ELAY TELEVISION OUTLETS )RAINFIELO, 4' TILE/RES. ' VIOLATION 'UMP & ABANDON SEPTIC TANK REINSPECTION ;WAGE PIT CU. FT. :ATCH BASIN )ISCHARGE WELL _ K)MESTIC WELL WEA DRAIN I00F INLET DLAR WATER HEATER 'IRE STANDPIPE 'COL PIPING • .AWN SPRINKLER SYSTEM ;AS RANGE ETER SET (GAS) ;AS PIPING PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) ELECTRICA MECHANICAL ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT r� Permit No../ (2 Date ° / 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 air .ication is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of t State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall ber Jmplied 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 Service Overhead Amount of Permit $ appeared materials and /or workmanship. SS. MIAMI SHORES VILLAGE No yo Registered Architect and /or Er leer Employing Electrician's Name ...� ' �- ,�nn •� • No 12 Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding (Signed) (Signed) 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 the site of t, w. such public notice or notices 1 as are required by the Act. The undersigned agrees to employ only such sub •contractors, worJt to be 'perform d under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. I Before me, the undersigned authority, a notary public, duly authorized 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 therein by him stated are true. Street 9y Notary Public, State of Florida Ele = al Inspector. ast r Electrician. to administer oaths and take acknowledgments, personally did sign the same, and that all facts 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 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. 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 .n U JaM,7 S /C CHECK ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT r� Permit No../ (2 Date ° / 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 air .ication is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of t State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall ber Jmplied 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 Service Overhead Amount of Permit $ appeared materials and /or workmanship. SS. MIAMI SHORES VILLAGE No yo Registered Architect and /or Er leer Employing Electrician's Name ...� ' �- ,�nn •� • No 12 Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding (Signed) (Signed) 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 the site of t, w. such public notice or notices 1 as are required by the Act. The undersigned agrees to employ only such sub •contractors, worJt to be 'perform d under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. I Before me, the undersigned authority, a notary public, duly authorized 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 therein by him stated are true. Street 9y Notary Public, State of Florida Ele = al Inspector. ast r Electrician. to administer oaths and take acknowledgments, personally did sign the same, and that all facts 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 BUILDING ELECTRICAL PLUMBING Owner of Building Architect MIAMI SHORES VILLAGE, FLO A D DATE 19 PERMIT N° 8000 k 574 149 Contractor's License No Contractor or Builder Legal Description Address of Building This permit is granted to the contractor or . il. named above . construct the b cation herefor in strict compliance with all ordinances pertaining there and w th the un plans, drawings, statements or specifications that may have been sub - ed to and approv at any time if the work is not done in compliance with such ordinances or if the pla i ar permit is granted is the understanding that the contractor or builder named above regulations pertaining to the work covered hereby whether shown on the plans o draw sibility for work done by his agents, servants or employees. Work to b performed under this Permit 7 Joey CONTRACTOR R BUILDER Subdi- vision Value of Project BY ©© 1 Amt. of Permit g or to install the equipment or device described in the appli- nding that the work will be performed in compliance with any y the proper municipal authorities. This Permit may be revoked anged without authorization. A further condition upon which this the responsibility for a thorough knowledge of the ordinances and s or in the statem. . d that he assumes respon- i j / INSPECTOR In consideration of the issuance to me of this permit I agree to pe e work covered hereunder in comRliance wi th a� 1 dinances and rag pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper a 'of Miami Shore* In accep this permit I psspne responsibility for all work done by either myself, my agent, servant or employee. AUTHORITY BUILDING ELECTRICAL PL!MBING Owner of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLO A ERMIT N° 8096 Work to be performed under this Permit / DATE ! 194 Contractor's'' License No. , BY AUTHORITY Architect I Contractor ...--2, ?� or Builder 4,- Legal Lot Bl. Subdi- Description vision Address of / i ,y Value of Amt. of- d Building / •� _ ..' _ P roject Permit- „t_ ,-` This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 or in the statem is or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. L. 0 . v . Signed• °- . 1 r . ' , A. r_ .. r' By INSPECTOR •1 In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinates% and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authori of MMia p S o r b s V 1] e., In accepting this permit I assume Tesponsibility for all work done by either myself, my agent, servant or employee. . ,. r'-, Permit d __ 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. No._ L1 _Street_d -_I_4._. � j am �I, 2 0 ,�` ) Employing d Electrician's Name__ _ / ___ s `- SI _ i No .,1__ 0 Street___L_Y _ w �J__ Location and Legal Description Lot__ f I , � Block___ ____ Subdivision_ 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 Repairs No. of Stories_ Owner's Name and Address __Street_ Service Overhead Underground Size Feeders Condiiit _____Main Sw. Type of Installation— Conduit____ — _________Tubing -B.X.L._______ Metal Moulding Amount of Permit $_____ % STATE OF FLORIDA, COUNTY OF DADE. } ss. (Signed)___ (Signed) Amps Main Fuses__-__.._— ____.____ -Amps Master Electrician Electrical Inspector. The undersigned applicant for this building permit does hereby certify that If understands and accepts h' / .ligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floriaa 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 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. 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 r----- - - - - -- of the above described constructio , 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 FIXTURES No. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST I CHECK -- ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. M TORS I HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit d __ 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. No._ L1 _Street_d -_I_4._. � j am �I, 2 0 ,�` ) Employing d Electrician's Name__ _ / ___ s `- SI _ i No .,1__ 0 Street___L_Y _ w �J__ Location and Legal Description Lot__ f I , � Block___ ____ Subdivision_ 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 Repairs No. of Stories_ Owner's Name and Address __Street_ Service Overhead Underground Size Feeders Condiiit _____Main Sw. Type of Installation— Conduit____ — _________Tubing -B.X.L._______ Metal Moulding Amount of Permit $_____ % STATE OF FLORIDA, COUNTY OF DADE. } ss. (Signed)___ (Signed) Amps Main Fuses__-__.._— ____.____ -Amps Master Electrician Electrical Inspector. The undersigned applicant for this building permit does hereby certify that If understands and accepts h' / .ligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Floriaa 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 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. 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 r----- - - - - -- of the above described constructio , 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 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT —Z Date - --/- -- — 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 co lied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. e '' 4 4 No. 4 0 Street - At E 9 1 - --- Owner's Name and Address _____ _ - ; Da Registered Architect and /or En neer_---_ ..... _._______ - __ ,..._ Employing Electrician's Name_ r No. .3 2_0, 1 : 4 - 5 4 _ __ _ I get Location and Legal Description Lot_ i t' te_ _ .p Block__ Subdivision n _ _ + __________ __ ____ ______-__-__ —_ Street and Number where work is to be performed —No Q Street___ /___4. State work to be performed and purpose of building (By Floors) New Building _Remodeling _Remodeling Addition _ Repairs No. of Stories -- 11 _______Main Fuses___ ____ — Amps Servi Overhead Underground Size Feeders_ Conduit__ _�_! __Main Sw.�____ Amps._______ ___ ______ Type of Installation— Conduit_______ Amount of Permit $.d A-4 C STATE OF FLORIDA, COUNTY OF DADE. } ss. B.X.L _ Metal Moulding_ � _ (Signed)._ (Signed) ectrical Inspector. The undersigned applicant for this building permit does hereby certify tha understands and accepts his o.¢ tions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, . .sled General Laws of Florida ermanent 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 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. 04401,:,? 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 ____ I on Expires Notary Public, State of Florida NOTE: A re- inspection fee bf $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. SPACE HEATER STRIP HEATER TOTAL CDNTR. LIST r 11 /0 • I / G v / ` O / iS .� i — -5"..o CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST 1 CHECK / $ J Permit MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT —Z Date - --/- -- — 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 co lied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. e '' 4 4 No. 4 0 Street - At E 9 1 - --- Owner's Name and Address _____ _ - ; Da Registered Architect and /or En neer_---_ ..... _._______ - __ ,..._ Employing Electrician's Name_ r No. .3 2_0, 1 : 4 - 5 4 _ __ _ I get Location and Legal Description Lot_ i t' te_ _ .p Block__ Subdivision n _ _ + __________ __ ____ ______-__-__ —_ Street and Number where work is to be performed —No Q Street___ /___4. State work to be performed and purpose of building (By Floors) New Building _Remodeling _Remodeling Addition _ Repairs No. of Stories -- 11 _______Main Fuses___ ____ — Amps Servi Overhead Underground Size Feeders_ Conduit__ _�_! __Main Sw.�____ Amps._______ ___ ______ Type of Installation— Conduit_______ Amount of Permit $.d A-4 C STATE OF FLORIDA, COUNTY OF DADE. } ss. B.X.L _ Metal Moulding_ � _ (Signed)._ (Signed) ectrical Inspector. The undersigned applicant for this building permit does hereby certify tha understands and accepts his o.¢ tions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, . .sled General Laws of Florida ermanent 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 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. 04401,:,? 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 ____ I on Expires Notary Public, State of Florida NOTE: A re- inspection fee bf $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship.