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150 NE 100 St (8)EVELYN C. SHUFELT 150 N.E. 100TH ST. MIAMI SHORES, FL 33138 -2317 Pay to the order of ACH RR 063100277 406 3 LOO 2 ??I: 00 3505 2333 2' L L L 2111 QD2_63- 27!631 FL 988 Bank of America Advantage- DATE: MIAMI SHORES VILLAGE Paint Color Approval and Agreement APPROVED: 9/a OWNER'S NAME: . r ADDRESS: / 570 6,&5 ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: CONTRACTOR & DENSE (if applicable) COMPANY NAME: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia Drip Cap/Drip Edge Soffit Roof Go 7 Flower Bins Shutters Awnings Chimney Doors and door jams Garage Doors Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features ccessory Buijngs Other OWNER'S AFIrIDAVIT: ertiFy that all the f going information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** YA/ a ;- Building Official Date /�c1 _r 1 PHONE: HONE: ` SOS• - U //E_ WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -843 Printed: 5/ 1;2002 Applicant: EVELYN SHUFELT Owner: SHUFELT EVELYN JOB ADDRESS: 150 NE 100 ST Contractor Local Phone: Parcel # 1132060132140 Fees: Description Amount FEE2002 -2446 Building Permit Application Fee $60.00 FEE2002 -2449 CCF $0.60 FEE2002 -2450 Notary Fee $5 00 Total Fees: $65.60 Total Fees: $65.60 Total Receipts: $0.00 Permit Status: Approved Permit Expiration: 10/28/2002 Construction Value: $900.00 Work: EXTERIOR PAINTING AS PEEDR AGREEMENT (OWNER BUILDER PERMIT) If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 vrith 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 krow,edge of the ordinances and regulations pertaining to the work covered hereby whetner 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: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with ail 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 responisibiiity for all work done by either myseif, my agent servants or employes. Signed. Bufldhig Permit Contractor's Address: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 8 & 9 BLK 16 LOT SIZE (Contractor or Builder) BY Page 1 of 1 Page 2 In'IPORTANT NOTICES 1 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 PROTECI'ED 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. ST OF FLORIDA, C i OF MIAMI -DADE Signatur of Owner 11 4 16 e/ lame and subscribed before me this day of gnature of % otary Pub SEAL: r.M .1SC1OW 40 g, , CC7+35 397 PERMIT APPLICATION STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida SEAL: Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: F-)..) S 1 9 S `p_ OType of Identification .Produced: PROPERTY OWNER / / Name ( t }r / ( ( 5 ' % /) ! !!/ ..„ Address 6 6 r TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. $ubmit 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 Job Address: Lot Complete the attached permit application which must be signed by the prope y 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 submitted along with this permit application. 5o Az-5 Zip PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. Folio Number f" "Qescriptiou of Wor Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. City State PERMIT APPLICATION ` �c 5 Zoning Linear Feet Square Feet Units Floors > Value of Work g 0 (2 , 00 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name V /06 License No. Address Telephone Fax Qualifier Name INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. $ubmit 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 Job Address: Lot Complete the attached permit application which must be signed by the prope y 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 submitted along with this permit application. 5o Az-5 Zip PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. Folio Number f" "Qescriptiou of Wor Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. City State PERMIT APPLICATION ` �c 5 Zoning Linear Feet Square Feet Units Floors > Value of Work g 0 (2 , 00 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name V /06 License No. Address Telephone Fax Qualifier Name ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair TV. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Ventilation, Cost Outlet, Wall Ductwork, Cost of Service, Temporary Periodic Inspections A/C Central 4 -7 Ton Fire Sprinkler System Fire Pump Outlet, Switch Fireplaces, Number of Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton 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 TYPE QTY. Minimum Fee TYPE Condensate Drain QTY. TYPE. Generator QTY. TYPE QTY. Refrigeration, Tons A/C Central, Tons 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 Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. 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. RECEIVED AND REVIEWED BY: DATE: SECTION BY DST E `/ / /�/ Q; Zoning Gr1J Electrical Mechanical Plumbing Fire Public Works Structural ' b" '1:02 Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) LI OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine ing Review Metropolitan Dade County (C.C.F.) $ (j 0 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $60, $ REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ s_t6 ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Date Legal Description Historically Designated: Yes No n�^ (f y _ Owner/Lessee / Tenant S(%r! f "! �� Master Permit # I 7 /6 5 v AE / 2 5 - &'v1h'b( I2/? Address Owner's Address Contracting Co. Qualifier SS# Phone • State # Municipal # Competency # Architect/Engineer Address Bonding Company Mortgagor Address Permit Type (circle one): WORK DESCRIPTION Signature of owner and/or Condo President Date FEES: PERMIT X ird RADON APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE /3 Job Address 1616t9-- , g /AV,S) Tax Folio Address Phone 30.5 - 7S Ins. Co. ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN ,04,Z4 frdiktit Square Ft. Estimated Cost (value) Boa 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 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. Furthermore, I authorize the above -named contractor to do the work stated. Notary as to Owner and/or Condo President Date lJdfary as to Contractor or My Commission Expires: My Commission Expires: IMP /t, , Signsf Co�,7: for or Owner - Builder/ / � C.C.F. • 6° NOTARY S � / Owner -B OFFt « SEAL GLADYS J VILLAR NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMLSSION EXP. MAR.22p BOND 6 O TOTAL DUE Date — ��oo to / Building 4 411400 G 100 Electrical Plumbing Structural Engineer BUILDING MIAMI SHORES VILLAGE, FLORIDA ELECTRICAL ❑ PLUMBING ❑ PERMIT ROOFING ❑ '/ �� Owner of Building Architect Contractor or Builder Legal Description Address of Building 6 - 14 ) - kA.) Lot l;. / o /t)‘ /oD S* 1 Bl. Work to be performed under this Permit A N_ • 46554 BY Date Contractor's License No. Su)? 3 8a /a / S IX / , 1b Permit: Su is - / 1 3204.'0–'1109 Notary: visiion Bond: Sq. Ft.: Radon: Q Value of 7 ✓ Amount of F� Project $ Z�b Permit: ) S •— .242062 s2 r & 0 reel 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 applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with an . 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 respon• sibility for work done by his agents, servants of e . ploy e . r Signed• (INSPECTOR) BY In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation% 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. 7677(1200 011 115I001-O ioRIT ' °U6 PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) 15 ,11004 Legal Description / Lessee /-Tenant V /,,j C, s q -Pe It Owner's Address "5 /Vie /Do f �, Contracting Co. Address Qualifier State# Square Ft. tr/Aig 7 L_- tom — Signature p f Owner and Date: fJ • ar! as to Owner and /or C ndo Commission Expires: i// 7 01-9 749A,.1 Competency # Architect /Engineer Address Bonding Company Address Mortgagor Address President Fire SS# - - Phone Master Permit 1/B Tax Folio If 126,4„...043 100 to Phone 758 - // 8 3 443 Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION 49 / y� ex t o r ; p N 64 0 OL5e Estimated Cost -100 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 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. Furthermore, I authorize the above -named contractor to do the work stated. sc Signature of Contractor or Owner- Builder Date: Notary as to Contractor or Owner - Builder My Commission Expires: Other / / "� I �r PERMIT FEE: APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering BUILDING ELECTRICAL PLUMBING ROOFING Owner of 'Building Legal Lot Description. Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA PERMIT IN? . 13462 n J� ❑ Work to be performed under this Permit /11 • ThAi 6 Architect or Builder /pal) /7644th /(' etiEsA) Contractor A re This permit is granted to the contractor or builder named above J constru \t herefor in strict compliance with all ordinances pertaining thereto and with the u drawings, statements or specifications that may have been submitted to an time if the work is not done in complianc with such ordinances or if the granted is the understanding that the co ractor or builder named above pertaining to the work covered hereby ethe won the plans or d done by his agents, servants or emp10 � ,,r'1 t I�I',��J//�Fjj Permit $ the building or to install the equipment or device described in the app'i derstanding that the work will be performed in compliance with any plans p rove by the proper municipal authorities. This Permit may be revokqd at any are ch ged without authorization. A further condition upon which thi$$ permit is es the esponsibility for a thorough knowledge of the ordinances and regulations or 'n the statements or specifications and that he assume g responsibility for work Subdi- vision Value of Amt. Project $ Signed• ECTOR In consideration of the issuance to me of s rmi perform the work covered hereundevl'ft'xfiance with al ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoriti of Miami Sjiores Village. In accepting 's permit I assume respo ibility for all work done by either, myself, my agent, servant or employee. BY DAT AUTHORITY Contractor's License No. "WG MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Building Inspector Owner's Name and Address Registered Architect and /or Enginee Name and address of licensed contractor___ ____: Location and legal description of lot to be built on: Lot Block Subdivision �a Street and Number where work is to be done / 512 4. 7",= <f State work to be done and purpose of building (by floors) New Building Remodeling Addition Repairs To be constructed of Kind of oundation oo Covering Estimated Total cost of improvements $ of Permit $ /D Zone cubage required Flan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public no •ce or notices as are required by the Act. The undersigned agrees to employ only such subcontrac s .n off' be e •rfo ineidoid this permit, as are licensed by Miami Shores Village. Remarks (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared a nd who, being by me first duly sworn, upon oa .of the above described nstruction, that he has are therein by him a Permit No.___ _ Disapproved(__ (S '. - s ed ) ate de Chairman 1 Member Member Council Approved ses and says tat he is the_ y read the foregoing application, and that he did sign the' same, and that all facts J S f atadd, Sworn to and Subscribed before me. PLANNI G BOARD_ ___I DATE Date and for no other purpose. No. of Stories to me well known, Notary Public, State of Florida My Commission Expires Member Member Member Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re-inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship.