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1249 NE 100 St (7)CONTRACTOR New Construction Name 1%Dut•1 :jdel 1467 License No. 9/050 O Z( LE Repair Add w � -4/ y l eV �f� Alteration Interior Telephoone 75 / 7 7/ Fax 75 ; Relocation of Structure Qualifier Na1p �„ /'. GtiJ� / PL�I/f�G Shell Only AM' A Q D1 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other RECEIVED OCT ®8203 INSTRUCTIONS - The following stcps r»nsi he taken to obtain a permit from the )Miami Shores Village: Step 1. Inspection Date Approved Correction Re- Insp'n Fee Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. A PPLICATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Address Date j� L Type Insp'n r� no Pa C7 Permit No. bP c.OV 3 bD Name Nl?lkibO'r - Address 1 �4C4 1\)F__ f lDU+ Company V'JOa� Phone # G I 18" 5 (o Apt. City State Zip ;ription of Work 'Par Ce`i ing Linear Feet xre Feet Units Floors to of Work Bldg Value Assessed/Appraised Value Id Zone Base Floor Elev. PERMIT APPLICATION Master Permit No. 81{� " nL� 7 1 0PS Subsidiary Permit No. ENGINEER Name License No. Telephone F Q0 cc aco a Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1° Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. 9 STATE OF FLORIDA, COUNTY OF MIAMI -DADE X Signature of 0 er 7 fl /-- 4 6.01,- Print Name 1 Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION STi OF OI3JIk 9OUN`FY i IAMI -DADE Swwto and subscribed before me this -�; _ `i • at w o otary ' � is -State day of f F1Ontl@ Vargas Commission #DD23198 SEAL: Expi e3 : l r 3, 2007 Bonded Atlantic Bonding Co., Inc. Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: Miami Shores Village 10050 NE 2nd Avenue Printed: 10 /10/2003 Applicant: CARYN NEWBORN Owner: NEWBORN CARYN JOB ADDRESS: 1249 NE 100 ST Parcel # 1132050080060 Signed: (INSPECTOR) Building Permit Phone: 305 - 795 -2204 Permit Number: BP2003 -1625 Permit Status: APPROVED Permit Expiration: 4/5/2004 Construction Value: $2,450.00 Work: paint exterior Page 1 of 1 Contractor VISCOUNT PAINTING & DECORATING Contractor's Address: 640 GRAND CONCOURSE Local Phone: 305 - 751 -7164 Legal Description: 5 53 42 GORDON SHORES PB 45 - 8 E25FT LOT 5 & W5OFT LOT 6 BLK 1 LOT Fees: Description Amount FEE2003 -6124 Building Fee $60.00 FEE2003 -6125 CCF $0.60 FEE2003 -6126 Notary Fee $5.00 Total Fees: $65.60 Total Fees: $65.60 Total Receipts: $65.60 OCT 14 PAID 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Date Owner's Name /%(i2 s 16i4 h./16644/E Owner's Address /, ,624' E N•• /0b Citythy ► State p Job Address (where the work is being done) /7-- A /0 City Miami Shores Vi11aze County Miami -Dade Is Building Historically Designated YES NO ✓ Contractor's Company Name (if applicable) V (ciGO ✓N 1 ?At NT�� Walls -r ( Fascia 4- AC- I Z Drip Cap /drip Edge Soffit - I j4 c_ ( � Roof W Flower bins r((A Shutters W IlcrrE Awnings V4 1441S Chimney 1.3/4c- Doors and door jams C 11 Garage doors VJ t.frTE Railings rc /I- Fences ti1/k Decorative metal e (/ All brick (simulated or regular) 4 - 1 1( Stucco banding {-k_ 11( Any other stucco features Accessory Buildings Other Signature Miami Shores Village Paint Color Approval and Agreement ,e4k,pt )14,4,c44.) Owner or Agent Zip Phone # 3313r 3eu 7Z • 3062 zip 3 313f Phone # 3. '? T -7 (�o All elements on the site must be listed and indicate the color to be painted A.... -h r , tmr >^ � ples Platinum Gray 71 Date APPLICATION APPROVED BY: Date / 4 / i/o 3 P& Z Offi al chc6 /1803 Wickham Gray HC -171 * *** * ****** * *** * ****** * *** * *** * ****** * *** * ****** * *** * *** * ** * *** * *** * ** * *** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ROB VISCOUNT Tel: (305) 751 -7164 • Beeper: (954) 896 -1800 Name Street f 2 J' . 100 5-r City .rt �Goi2E5 State Telephone Number '1ale62- ESTIMATE Viscount Painting & Decorating Residential • Commercial Custom • Quality Interiors • Exteriors • Pressure Cleaning • Faux and Creative Finishes Proposal Submitted To: with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes. accidents, or delays beyond our control. Street City Date of Plans Architect Respectfully Submitted Licensed & Insured Broward - CC # 92- 6769 -PU -X Dade - CC # 94 BS00214 Work To Be Preformed At: MooieO PAINTS Pc.( State We hereby propose to furnish the materials and perform the labor necessary for the completion of: • PRESSdRC anti, R(P, PRfizcE Am) - Prier EReA, /act 551)t Ce69,1 cerixf I1,usC 641.14/4 (5 5 , Attie 4S v B Ph h . r (t - Ie f ireuLi - ctI1 `. CtAtty d/b Kilt ii,(464/ 00,01 -Lk/ G€,Eh(/ 54 0,66-- - B w'( se208 5- roe (3y BRA ! .4/101/E 4tq e0SE c4 P EuNI f ly Gov SvLF bori EIS • 11 A'7i Q' fi/ & x, �G , (51),KE P46e, 1 M(u Ar 1 1 4 - 4 - u,vE CRACic Ail 411444E a, 04 f w1 T1* EG 5- reweRt - . eitoy ■(-Ay SAPS t ag. SERE op(s onl 6MI✓5 , 6*Sc k tdiis oof S, Deme. o3.# S k(D A-Ny Pf oet:eM A-s . ? - " hti/ oe Pos - v oar• r 01- ( S-r enter • AePtY 'To 1. P -1 t�f E - u DEt2Go 4 - 1- a- - rt G W A1 V S(4, 6' ?vas , t i ,aeas ri 5 fU14 t qe —&(A/6 bo� `f FE H1rTi� t'gful..s Rots-9 C Svc 4CE a 1i(1 eartA ; m /TO i G t , I V l il a & 66 TNfr5D T 1 P F 1 ; 0 5 . 691A doU ( 1 P,eo Vt PG evegt te-ter Coil c r, With )t Ek S (5 eTTs) tisrt4 $e 1.1q t•;tt\i ilAnKES ‹DP,u►JC 4eDK. - g SCML coSS . n(erc : Pkcnh i 8E Rcectaq Rot-3) t'Skit -6(Z.o - rb 44/e4E 411 EIEJ JnI lei 41-p t . g 2-n13' co q kPpty 2n9 Co _ 1 Jt 04-1". T .� USiJ �v d itJ /UcrbRES 4P -Unic' 1 1,60K C44 bov -S( c� • tbT>~ - 3/4C -Rot,- kk. P 9kePcy A- Tort, Po Mel- u1,1%g co A.4 g 4 ettaoiC ' ' 5 rn) q01\11 01r 4ov5 ?FUME- /5 AlccesS ( . A:Ar .:Jo E9 o,J Pyt.b4 All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: Dollars ($ Note - -- This estimate may be withdrawn by us if not accepted within days. ACCEPTANCE OF ESTIMATE The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date Signature ESTIMATE Viscount Painting & Decorating Residential • Commercial Custom • Quality interiors • Exteriors • Pressure Cleaning Faux and Creative Finishes ROB VISCOUNT 4© Tel: (305) 751 -7164 • Beeper: (954) 896 -1800 Name it) + !K Street Proposal Submitted To: City State of Telephone Number • ?vXGINk AND Cos r dr 7'i2M(1 IN Cu 32 /A) 71116 ,CS 40404 Go„ / v 7 7 f 4. Des; Gt.1 AWA-u, & v90 nJ yovit Rf � ACCEPTANCE OF ESTIMATE Licensed & Insured Broward - CC # 92- 6769 -PU -X Dade - CC # 94 BS00214 Work To Be Preformed At: Street City State Date of Plans Architect We hereby propose to furnish the materials and perform the labor necessary for the completion of: , Ap p ui (Z.> 1'1 r4 t S 4- Cq(rl- 5 To Ate TP-lµ a-4 L 5TH , 1.41-r* GE t.T A MC -12;;;;2 LDV1/i D Mara it 6 Si./ WIZ 5itlu s 4 RAJA E , e6.- r r SLICKS p AI S 160-5 oP (9 - Prx - S7 )ac smvi4 + 4. UP &'D ofJ , 6,t. .t•c.E, Q- rw2 ►o(� �oza�s, L ;GoGMtIE g,404E c t fL ceEt ittJtp on( (v\J >S t 'DE USlt■1 "BEtJSbok tr A ‘s " aP- UnIE gbDe- G4P9 t oKs SI EC i (o -0� 4:4s D4 99L./ (2)c is - At) ozoti Cbtomt,i JS(4 - 6er.i aet it t.1 ►t(roAE on( -Cum tyJ ►14(J4S -(4P E coS'c) . kwrv o't s , Q *F4944 aeAd 4 ?d56 z0 N/r/lE ,ays1( 5ak 'E SSE 4'44 PEEUn/`‘ • ® APPIA( A- T 71.4 Redk/ e` 1r v5 A/4 7 EW 4014rN MALES J`f,e60 `- ,4fr / 4-TrkL t5it//sff Co ()Sid rr frip,4 -44p oQ 4/L%ove. 565.00 RaeA/rep 1 A 4i4L Pv4t /r( PPA r"sy/ST t kV> 820PvUT v�r 0 Mr AAd,K'u t tauSTee- n!p 4r4E rS A-Atp Opt/ 465 Sde roL A' 4 ger6170/4, 8Qo‘it Go /4 e,,, 9r' /G 3a/Ty 4 1 o,f . . tit r 0,4d.-cry y �,4 -pv"T syS'Te -kt r 5 e5 2 , k S EP ,G E r? r ,0„.„( 86_PR_o✓ -1 v ®opt/ yout ci r All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of: Dollars ($ AMMI with payments to be made as follows: /L(Ae1- 4' 57-41 1-T- D ' Respectfully SubmitteA1111►1: C/A, P,M r- PL/ e5 r/eo / Acit n) , Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon stakes. accidents, or delays beyond our control. Note - -- This estimate may be withdrawn by us if not accepted within days. The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date Signature Moore] PAINTS ELEC'T'RICAL T1'Pl: Minimum Fee (in'. T''PE Dryer (in'. 'rl'Pi: Outlet, Appliance ()Ty. 'i' i'i: Service Repair crr V. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL 'fl'PP. Minimum Fee (1T1'. TYPE Condensate Drain Q'I'1'. Tv1'l: Generator QTY. "TIT. Refrigeration, Tons Q►'fl'. A/C Central, Tons QTY. Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUNIRING TyPl.: A/C Condensate cm'. Tvi Drains, Roof ()Ty. TYPE Miscellaneous Fixture ()Ty. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. I RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning / - ° — j / s f�?� % / ,-'. Electrical ,e7- Mechanical Plumbing Fire Public Works Structural Building Official OCT - 9 21 Page 4 OFFICE USE ONLY c'IIL(•I:LISr ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PER\ii FE LS Metropolitan Dade County (C.C.F.) $ • `) 0 (sq.ft. = x/1000 x0.60) $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: 03 (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ CONDI'T'ION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building :;_ Lot MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N° 15870 ❑ Work to be performed under this Permit Architect Contractor or Builder Legal Description Address of Building CONTRACTOR OR BUILDER BI. Subdi- vision Value of Project $ DATE Contractor's License No JJ ;IP ? ' 195 Amt. of Permit $ v This permit is granted to the . ntractor 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 or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: , ;,t +l BY i i , ! l,r[ :�. 'Svc . IN ECTOR 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. BY AUTHORITY Application is hereby made for the approval of th' det. iled statenien• of the plans and specifications herewith submitted for the build- ing or o hcr structure her. i. described This t t licatic . is made in compliance and con cm ty w.th the Building Ordinance of Mia u Shores Village, t ior'da, and all pro isions of the Law, c f the Statc. of 1•h.rid. all o d nances of Mi an Shores Village and all rules and regu'a'ions of the Building Div.:. i of :.run• Sho, ' illage i- '1 c o pled wi ;h, whether herein specified or not. A copy ot approved plans and specificati,ns must be ket'• at buitd.ng durin progress of tl.e work. Owner': Name and Address. Disapproved . _ _ -__ ____ ..... ( Signed) Chairman Member ___. Member _ Council Approt ed MIAMI SHORES VILLAGE BUILDIN INSPECTION DEPARTMEN• APPLICATION FOR BUILDING PERMIT Date i 'A No Street_ ._ n i Registered Architect and /or Engineer _ Name •nd address of licensed contractor _..__l___- Location and legal description of lot to be built on: Lot_ __ Block. Street and Number where work is to be done_ State work to be done and purpose of building (by floors) J- uilding Inspector Subdivision. its New Building. _ - Remodeling._ Addition._ To be constructed of ___ . - Kind of foundation _. __ Q� Estimated " .tal cost of improvements $.. l Amount c`. Permit $. Zone ^ubage required __. Plan Cubage_.___. .__. Distance to next nearest building.. .. _Size of Building Lot Maximum live Load to be borne by each floor . and for no other purpose. _.. Repairs. - No. of Stories . Roof CCOVyring _ hereby submit all the plans and speci:i..ations for said building. All notices with reference to the building and its construction may be sent to _ -- - -- - - -- The uncle signed appli ant for th's building pc• does hereby certify i'tai he understands and accepts his ;•bligatious ,is an cnii•lo.er of 1 bor under he Florida Workmen's Compensation Act being S. -t:on " "tiB Cni p led Gen al Laws of Florida P r an:n S •Ippl. vent. and h s compl ed v th he prov'aons thereof, and will require s•in l r iiar co . ian.e from ail contractors or sub contractor:, cniplo .ed by hint in the wo k to be p rf med under th s pern it and • ill post or caul to be posted fur inspection on the site of the work su -h public not e or .otices as are requir d by the Act. The u ,1.r igrr -d agrees to employ only such , ihcontr ctors, on work to b perfurn, cl der this permit as are licensed by M am. Shores it . ge. Remarks_ (S'g•ied- - - -- -- --- --- STATE OF FLORIDA, COUNTY OF DADE. Ss. Before me, the undersigned authority, a notary public, duly authorized to adir.:nister oaths ..nd take acknowledgment. per:onall: ap- peared and who, being by me first d lv vworn, upon oath depoees and says that he is the .. ot th aboc de c ibed istruction t. . 1 has careially read the foregoing application, and that he did sign the same. and it at , facts therein by hum stated are ie. Permit No. -_� �' l /__ O _ . Date. '_. _ -. A . _. Read, Sworn to and Subscribed before me. Notary Public State of Florida My Com:nis; ion Expires. .. _..... . PLANNING BOARD .DATE Member .... ..__. Member .. _ ,19 to me well known, Member Date Disal.rrotrci Date NOTE: A charge of $1.00 will be made for snaking corrections c- - li ages to this application ft.•r :.pproV al 1: s I . , u bta.ried from the Plant ng Board A re- Inspection fee of $1.00 will be charged when such re- inspection is m: :r• ncc•es -ar) by improper nnticc fc r insp- t•.r• or l i ty niatenals and /or workmanship.