PLUMBINGcyf-
Permit No S
6 ?
Owner's Name and Address
Feet of Drain Tile__
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
Date PR )'l
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.
c/A50/1/
No._
Registered Architect and /or Engineer _________ —
Employing Plumber's Name__MJA_Mi____ .7? .C.Cfi_______D t
Location and Legal Description Lot_______-_ __ ______ _______ ___________ Block_
Street and Number where work is to be ___ $ 2
State work to be performed and purpose of building (By Floors) Re -,4y
New Building Remodeling Addition
Size Septic Tank Type of Tank Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $ - — — --
No. - - 2'7 Street-- -- eT \S C S 7
(Signed)_ - --1 -
Repairs No. of Stories .......
( Signed) ____
Subdivision
treet / / S t
_et/ /
Street__1v
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo ed 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 su p c notice or notices as are
required by tlie Act. The undersigned agrees to employ only such sub- contractors ork to be .er : ed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
,herein 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
CLOS[TB
BATH
T UBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINK°
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NB
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL.
CONTR.
LIST
CHECK
cyf-
Permit No S
6 ?
Owner's Name and Address
Feet of Drain Tile__
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING
Date PR )'l
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.
c/A50/1/
No._
Registered Architect and /or Engineer _________ —
Employing Plumber's Name__MJA_Mi____ .7? .C.Cfi_______D t
Location and Legal Description Lot_______-_ __ ______ _______ ___________ Block_
Street and Number where work is to be ___ $ 2
State work to be performed and purpose of building (By Floors) Re -,4y
New Building Remodeling Addition
Size Septic Tank Type of Tank Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City —Well Size of Soakage Pit
Amount of Permit $ - — — --
No. - - 2'7 Street-- -- eT \S C S 7
(Signed)_ - --1 -
Repairs No. of Stories .......
( Signed) ____
Subdivision
treet / / S t
_et/ /
Street__1v
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo ed 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 su p c notice or notices as are
required by tlie Act. The undersigned agrees to employ only such sub- contractors ork to be .er : ed under this permit, as are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, }
ss.
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administ oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
,herein 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
Pwznit No.. -.._
1-
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`
Registered Architect and /or E
Employing Plumber's Name
Size Septic Tank
Feat of Drain Tile.
Nature of Water Supply: City —Well
Amount of Permit $
STATE OF FLORIDA, }
SS.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
My Commission Expires
I•
- -
Location and Legal Desc(• ion Lot._ / - __-- ._-- ........ Block__
Street and Number where work is t� be performed —No_
State work to be performed and purpose of building (By Floors)
No.__ !-! Street_-
' Nol Ail __ Street
New Building_ ...... - --- ...- -- -_ _..- _.._____ Remodeling_____ _______ Addition____. ............... Repairs ......... No. of Stories.
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
-- — ( Signed) --
ubdivision
Notary Public, State of Florida
0
Plumbing Inspecto4l,„
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made• necessary by improper notice for inspection, or faulty
materials and /or workman hip.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob;,_rtions as an employer of labor •
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per*, (ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors 'mployed 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
hennaed by Miami Shores Village.
CL
BATH
Tue6
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LAST
CHECK
CHECK
--
SLP1'IC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
Comm .
LAST
i r
- .
CHECK
Pwznit No.. -.._
1-
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`
Registered Architect and /or E
Employing Plumber's Name
Size Septic Tank
Feat of Drain Tile.
Nature of Water Supply: City —Well
Amount of Permit $
STATE OF FLORIDA, }
SS.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
My Commission Expires
I•
- -
Location and Legal Desc(• ion Lot._ / - __-- ._-- ........ Block__
Street and Number where work is t� be performed —No_
State work to be performed and purpose of building (By Floors)
No.__ !-! Street_-
' Nol Ail __ Street
New Building_ ...... - --- ...- -- -_ _..- _.._____ Remodeling_____ _______ Addition____. ............... Repairs ......... No. of Stories.
Type of Tank Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
-- — ( Signed) --
ubdivision
Notary Public, State of Florida
0
Plumbing Inspecto4l,„
Master Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made• necessary by improper notice for inspection, or faulty
materials and /or workman hip.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob;,_rtions as an employer of labor •
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Per*, (ent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors 'mployed 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
hennaed by Miami Shores Village.
BUILDING ❑
ELECTRICAL ❑
PLUMBING 2
ROOFING ❑
❑
Owner of
Building
Architect
Contractor •
or Builder 4/, r^% "� e
Legal
Description
Address of
Building
Lot
0 s
MIAMI SHORES VILLAGE, FLORIDA
DATE 4 f
PERMIT N° 5289
Signed.
Work to be performed under this Permit —_
B1
<
CONTRACTOR OR BUILDi3R' BY
0
to 2 4 - FL 6 c4 c�
Subdi-
vision
INSPECTOR%'
Value of
Project $
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 responsibility for work
done by his agents, servants or employees.
+
t
In consideration of th issunce to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in ° ict fortuity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I ass}lmeo�si�J}ity for all work done by either, myself, my agent, servant or employee.
Contractor's
License No. ,
–
9
Amount of / '
Permit $ ''
BY •
AUTHORITY
195
0 .±
G�f MIAMI SHORES VILLAGE
00 PLUMBING INSPECTION DEPARTMENT
e-)@ APPLICATION FOR PLUMBING PERMIT
Date__ _ (*YL 4.?
Application is hereb he approval of the detailed statement of the plans and specifications herewith submitted for thlbuilding or other
structure herein esc ' 7us application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of t eaws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Vill ge s11114o3=cornplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during prog ss of work.
Permit No. 96 3
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
Owner's Name and Address .
Registered Architect and /or Enginee
ss.
Employing Plumber's Name
Location and Legal Description Lot____ Block
Street and Number where work is to be performed—No _________
___—
77 r
State work to be performed and purpose of building (By Floors
New Building Addition
Size Septic Tank -� Type of Tank Capa :ity Gals
Feet of Drain 11 Dist. Feet of Tank or Drain Field from Well
i h f
Nature of Water SupplyyM Well Size of Soakage Pit
umbing Inspector. C
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
My Commission Expires
' No Street
No Street
—Street
S u.bdivision
pairs No. of Stories
!r
Master Plumber.
C j 'J l
Before me, the undersigned authority, a notary public, duly authorized o( administer the and tak acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
7-,
,
)
e
d
CONTR.
LIST
CHECK
C W)
i ni, -,
f.i
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
U,,�^''Q
"`� 1 '
n
C Q � ? � -
O
CONTR.
' LIST
(1
i
I
t 001
fk 0��
( 1
CHECK
G�f MIAMI SHORES VILLAGE
00 PLUMBING INSPECTION DEPARTMENT
e-)@ APPLICATION FOR PLUMBING PERMIT
Date__ _ (*YL 4.?
Application is hereb he approval of the detailed statement of the plans and specifications herewith submitted for thlbuilding or other
structure herein esc ' 7us application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of t eaws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Vill ge s11114o3=cornplied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during prog ss of work.
Permit No. 96 3
Amount of Permit $
STATE OF FLORIDA, t
COUNTY OF DADE.
Owner's Name and Address .
Registered Architect and /or Enginee
ss.
Employing Plumber's Name
Location and Legal Description Lot____ Block
Street and Number where work is to be performed—No _________
___—
77 r
State work to be performed and purpose of building (By Floors
New Building Addition
Size Septic Tank -� Type of Tank Capa :ity Gals
Feet of Drain 11 Dist. Feet of Tank or Drain Field from Well
i h f
Nature of Water SupplyyM Well Size of Soakage Pit
umbing Inspector. C
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
My Commission Expires
' No Street
No Street
—Street
S u.bdivision
pairs No. of Stories
!r
Master Plumber.
C j 'J l
Before me, the undersigned authority, a notary public, duly authorized o( administer the and tak acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
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
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
J PERMIT N° 9039
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $
DATE 195
Contractor's
License No
Amt. of
Permit $
CONTRACTOR OR BUILDER BY AUTHORITY
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 ( a 'on
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 or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed • BY
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 accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. '
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 2819
Architect
Contractor
or Builder
Legal Lot
Description Bl
Address of
Building
DATE
Contractor's
License No
1
195.
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
This permit is granted to the contractor or builder named above to construc 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 tho 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 statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. -' -'' BA -
Amount of
Permit $
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.
d
CONTRACTOR OR BUILDER BY AUTHORITY
Penni. No. " " 1 %
: is Lercby made for the approval of the detailed statement of the plans and specifications herewith sub, r• .1 for the building or other
;tructurc herein described. This application is made in compliance and conformity with the Building Ordinance of Mix ! Shores Village, Florida,
End all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic— of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spa fications must be kept at
',lidding during progress of work. n �l ^� �rr Qn
')wner's Name and Addiess..THOJY11'4.S_ _ CQLL I No. e2 s __ -__ -- sty
eet.Ps.L�.
.egist Bred Architect and /or Engineer.....____ -
?mploying Plumber's Name N0.- - - - - -- Street
0-45:r 2 of Lai rr77rr�� Muirm SHc RES
Location and Legal Description Lot l5 ' 1 It' Bloat �I I SubdlvWon.S.E C.>r C' N._JSfQQ.�__
Street and Number where work is to be performed —No (726 Street.t • ' 4.E• 9.114 J lam.
State work to be performed and purpose of building (By Floors) ____;i .S.TALL - -_. S:F
New Building Remodeling_ _ Addition Repairs ... Nc of Stones
CONTR.
LI •T
CHICK
SEPTIC
TANK
CONTR
LIST
CHECK
BATH
CLosrrs Tuas
SEwea
CO NN.
STATE OF FLORIDA,
sa
COUNTY OF DADE.
SHOwIR•
DRAIN
FIELD
Amount of Permit $ 1 `
LAVA•
TORII•
SOAKAGE
PIT
MIAMI SHOES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
SINKS
GREASE
TRAP
SLOP
SINKS
SOLAR
HEATER
LAUNDR
Tu0•
Dam.
WILL
URINALS
SPRKLR.
SYSTEM
(Signed)._
CATCH
D A•IN
S IM'O
POOL
FLOOR
DRAIN
Date .._O. -C.T,, .. 3 0 . g0._.
DRINKING
FOUNT'Ne
Size Septic Tank__. -- -.--- •-- -- -_----- --- --- - - - -•- _. ....Type of Tank__ Capacity Ails..
Feet of Drain Tile.------ - -- - -- ---- --- ------- - - - --- _Dist. Feet of Tank or Drain Field from Well. --- ....._ _...
Nature of Water Supply: ..... of Soakage Pit
(Signed) ---a -- -a -i.lA ... ...0
Flumbin3 Inspector
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e n,lloyel of taht i
unc'.cr the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent 'upi lenient, and alas
1„•d with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y hint in • c _ c is
t under this permit; and will post or cause to be posted for Inspection on the site of the work such pllhl' notice T. no leer 45 a-
r.equ'red by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed 'a this d
Licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, periur.e. ; . ppearet.
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 reed the foregoing application, and that he did sign the same, and tout all acts
therein by hin, stated are true.
My Commission Expires Notary Public, State of Florida
ou.?i&
ToT..L
FIsTI RI•
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•neoeswy by trnproper notice for inspe -eon, (sr truly
materials and /or workmanship.