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1310 NE 101 St (6)Tax Folio // „nes- ,2 00 Ie O Legal Description / / � K./ fsdi Owner / Lessee / Tenant i /f / /PC /2 o,o4'4) Master Permit # 32-3> Z Date .?e - Z' a lZ - Job Address /370 /16-70 ( S ? Owner's Address /5/e 7 E /(9/ 9f Phone Contracting Co. P- //s //e/ X,C/aAddress 07 ,(/H./ I ZM /e, Qualifier //IG4 ; PERMIT APPLICATION FOR MIAMI SHORES VILLAGE SS# Phone 6/;7-7700 State '�C /Z- Municipal # Competency # Ins.Co. DI/f'/ GIfi2a //S/3eAfi Architect /Engineer Address G Bonding Company Address Mortgagor Permit Type(circle one): BUILDING ELECTRICA PLUMBIN CHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ie /d5 .2 / 46/47eFx_ ,O /fl 9==/ 5 ' 7 D SSYS Square Ft. Estimated Cost(value) 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 state Signature of owner and /or Condo President gnature of C Date: Date: $2/777 My Commission Expires: Address ,i !,.,�.' lei: Notary as to Owner and/or Condo President fr of -/ as to Cplgt4VARRarfgn ° .g 1 7) "y'Wis My Commission I x &zteaI own FOR Produced I.Dt Type and number of produced: ** * * * * * * * * * * * ❑ 40ID takei*n oath, * /h' h * ** �{ ,DID NOT take an oath. FEES: PERMIT / lv ' j RADON C.C.F. NOTARY t ¢ TOTAL DUE 2)9,5 APPROVED: Fire Other Building Electrical Mechanical /Plumbin: ' ' (ineering • ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING BATH TUB BIDET DISHWASHER DISPOSAL DRINKING FOUNTAIN FLOOR DRAIN GREASE TRAP INTERCEPTOR LAVATORY LAUNDRY TRAY CLOTHES WASHER SHOWER SINK, POT /3 COMP. SINK, RESIDENCE SINK, SLOP TEMPORARY WATER CLOSET URINAL WATER CLOSET INDIRECT WASTES WATER SUPPLY TO: A/C UNIT FIRE SPRINKLER HEATER -NEW INST. HEATER - REPLACE LAWN SPRINKLER -WELL SWIMMING POOL WATER SERVICE SEWER CONNECTIONS UTILITY -SEWER UTILITY -WATER SEPTIC TANK RELAY DRAINFIELD, 4" TILE/RES. PUMP 8 ABANDON SEPTIC TANK SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING ELECTRICAL MECHANICAL UNIT I Z I FEE T 4 110 4 30 ITEM SWITCH OUTLETS LIGHT OUTLETS RECEPTACLES SERVICE TEMPORARY SERVICE SIZE IN AMPS SERVICE REPAIR/METER CHANGE APPLIANCE OUTLETS RANGE TOP OVEN WATER HEATER MOTORS 0- 1 HP MOTORS OVER 1- 3 HP MOTORS OVER 3- 5 HP MOTORS OVER 5- 8 HP MOTORS OVER 8- 10 HP MOTORS OVER 10- 25 HP MOTORS OVER 25-100 HP MOTORS OVER 100 HP A/C WINDOW AIR CONDITIONERS STRIP HEATER GENERATORS TRANSFORMERS GENERATORS TRANSFORMERS GENERATORS TRANSFORMERS SPECIAL PURPOSE OUTLETS COMMERCIAL SIGN TUBES SIGN TRANSFORMERS SIGN TIME CLOCK FIXTURES ANTENNA TELEVISION OUTLETS VIOLATION RE INSPECTION UNIT FEE ITEM SPACE HEATERS CENTRAL HEATING A/C (WIND) A/C (CENTRAL) DUCTWORK REFRIGERATION PROCESS AND PRESS PIPING UNDERGROUND TANKS ABOVE GROUND TANKS U.F. PRESSURE VESSELS STEAM BOILERS HOT WATER BOILERS MECHANICAL VENTILATION TRANSPORTING ASSEMBLIES ELEVATORS /ESCALATORS FIRE SPRINKLER SYSTEMS COOLING TOWERS VIOLATION RE INSPECT ION UNIT I FEE ITEM PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date ?/Job Address 13/0 /1/, /b .�7- ax Folio // 3,Z 12 c - ©O / ° e ' - 1' Master Permit # J J Legal Description Owner / Lessee / Owner's Address Contracting Co. PATE H4A)/l /Y -- N7 Qualifier SSI - - Phone /ill /d0v State # Architect /Engineer Bonding Company Mortgagor Permit Type (circle one WORK DESCRIPTION Signature of Owner and /or Condo President Date: Zoning Mechanical Competency1 Address 2/1/6 Fa t Address Address Address BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN 6 L O l 14. Square Ft. Estimated Cost '5)-- 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. Signature of Contractor or Owner-Builder Date: Phone Ins. Co. Notary as to Owner and /or Condo President otary as • Contractor My Commission Expires: My Commission Expires: * . * . * * * * * * * * * PERMIT FEE: Fire Other Building Plumbing - / t Y lb �g ni Bering Electrical n PJJr3L : , $v$Jb FLORIDA MY COMMAISSION EXP. APR. 3,1995 6ONOE THRU GENERAL INS UND. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 7 _ 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 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 /Le.__L' -_ IA/Pk I No. ____. Streete /— Registered Architect and /or Employing Plumber's Name_ ,Pb i. O .1 d ) —rx No ._ `1_ %/ /F Street___ / J� Location and Legal Description Lot 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 . . ........ ..... Size Septic Tank___.__ Feet of Drain Tile_ Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, ss. COUNTY OF DADE. Blorti Type of Tank__ _Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit Capacity Gals. (Signed)_ Street Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig . j t"' s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanen 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. ( Signed ) - -- Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to admffiister 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. 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 insperVnn, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE U CATCH BASIN FLOOR DRAIN DRINKING FOUNT' y� /& PI 4 (Y J 4 / ry TOTAL FIXTURES CONTR. LIST / / 2 CHECK __ 2 o' 1 2S' �p 3. SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWING POOL &AP #4 /Bit' a CONTR. LIST / / gyp CHECK 9 . OG _ 2,0 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 7 _ 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 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 /Le.__L' -_ IA/Pk I No. ____. Streete /— Registered Architect and /or Employing Plumber's Name_ ,Pb i. O .1 d ) —rx No ._ `1_ %/ /F Street___ / J� Location and Legal Description Lot 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 . . ........ ..... Size Septic Tank___.__ Feet of Drain Tile_ Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, ss. COUNTY OF DADE. Blorti Type of Tank__ _Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit Capacity Gals. (Signed)_ Street Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig . j t"' s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanen 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. ( Signed ) - -- Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to admffiister 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. 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 insperVnn, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building MIAMI SHORES VILLAGE. FLORIDA H ERMIT N? 2528 Architect Contractor or Builder Legal Lot Description Address of Building CONTRACTOR OR BUILDER Bl DATE 195 Contractor's License No. Work to be performed under this Permit Subdi- vision Value of Project $ Amount of Permit $ BY AUTHORITY 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 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 ac- cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. Permit No Size Septic Tank Feet of Drain Tile Nature of Water Supply: City—Well Amount of Permit $ SS. _Type of Tank 00 (Signed) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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__ %i No Street._ Registered Arc ect anu/or Engine te__ - i Employing p1fm� s am 24 . ____ )-3 & I Street / Location and Legal Description Lot Block Subdivision • e' Street and Number where work is to b erformed—No.7_3/ 0 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories / / Street Capacity Gals. ist. Feet of Tank or Drain Field from Well ‘.t t ( Signed) My 9mmission Expires Notary Public, State of Florida Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accenis his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florid _Permanent Supplement, and has com- plied with the provisions thereof, and will require similar cotnpliance 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-contractois, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, t COUNTY OF DADE. 1 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-ins ection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and/or wo anship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIWG POOL CONTR. LI ST CHECK A Permit No Size Septic Tank Feet of Drain Tile Nature of Water Supply: City—Well Amount of Permit $ SS. _Type of Tank 00 (Signed) MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 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__ %i No Street._ Registered Arc ect anu/or Engine te__ - i Employing p1fm� s am 24 . ____ )-3 & I Street / Location and Legal Description Lot Block Subdivision • e' Street and Number where work is to b erformed—No.7_3/ 0 State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories / / Street Capacity Gals. ist. Feet of Tank or Drain Field from Well ‘.t t ( Signed) My 9mmission Expires Notary Public, State of Florida Size of Soakage Pit Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accenis his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florid _Permanent Supplement, and has com- plied with the provisions thereof, and will require similar cotnpliance 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-contractois, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, t COUNTY OF DADE. 1 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-ins ection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and/or wo anship. Permit No.. -:_ - Qua Application is hereby made for the approval of the detailed statement of the plans and specifications her ith s I• fitted 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al building during progress of wo . Owner's Name and Address. / ' . -- --_.__. No Registered Architect and /or Engineer Employing Plumber's Name. . 42... � : � _•_ _ - _ - No Street_ Location and Legal Description Lot__- __._.._.__.__. - - -_ __ ___ _ — Block.__.__._,/ --- ____ -- c Street and Number where work is to be performed —No._ . 3_4 - 20._ ______ ___.____ Street- ) 4 , , State work to be perfor med and purpose of building (By Floors) New Building -10" Remodeling Addition Repairs No. of Stories Feet of Drain Tile Nature of Water Sup Amount of Permit $- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed). Date Street Size Septic Tank Type of Tank_ _ Capacity Gals. - Dist. Feet of Tank or Drain Field from Well Well /_.______._•- .-- __.. _ Size of Soakage Pit Subdivision 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 Pennanent 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. a- S' (Signed) ` /r-- __ ___,S) Master Plumber. STATE OF FLORIDA, l as. ®/ `�°' COUNTY OF DADE. ( � J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 lac 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 faul materials /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY TUSB URINALS CATCH BASIN FLOOR DRAIN • DRINK, NO FOUNT' NS - / ^f TOTAL FIXTURE, CONTR. LIST / /�^ / CHECK c., /�v _' S ^ � aS �� T / t om _ 7,S_ - - � PS SEPTIC TANK SEWER CONN. RAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR NEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL . CONTR. LIST CHICK / 4 CAAAC• Permit No.. -:_ - Qua Application is hereby made for the approval of the detailed statement of the plans and specifications her ith s I• fitted 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 Divisior of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al building during progress of wo . Owner's Name and Address. / ' . -- --_.__. No Registered Architect and /or Engineer Employing Plumber's Name. . 42... � : � _•_ _ - _ - No Street_ Location and Legal Description Lot__- __._.._.__.__. - - -_ __ ___ _ — Block.__.__._,/ --- ____ -- c Street and Number where work is to be performed —No._ . 3_4 - 20._ ______ ___.____ Street- ) 4 , , State work to be perfor med and purpose of building (By Floors) New Building -10" Remodeling Addition Repairs No. of Stories Feet of Drain Tile Nature of Water Sup Amount of Permit $- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed). Date Street Size Septic Tank Type of Tank_ _ Capacity Gals. - Dist. Feet of Tank or Drain Field from Well Well /_.______._•- .-- __.. _ Size of Soakage Pit Subdivision 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 Pennanent 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. a- S' (Signed) ` /r-- __ ___,S) Master Plumber. STATE OF FLORIDA, l as. ®/ `�°' COUNTY OF DADE. ( � J Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare 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 lac 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 faul materials /or workmanship. F�