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PLUMBING PERMITV rv 4 y i S‘-1 o ( Dace S/14 Joo Aaaress 13`DO 0= 101 S? sr 'tax rolio Legal Description L.OT 2 , BLV. 1 1 �UNLI k J4 W -- a e J Owner / Lessee / Tenant XPeoples Gas System, InC. Master Permit 4t t/4 gs Owner's Address 16101 West Dixie Hwy. N.Miami Beach 33160 Phone 940 - 0139 Contracting Co. Peoples Gas Address same Qualifier Jesus Vega ss# 261 - 41 -.4430 Phone 940 -0139 /I4, to 1 po 4) X - 73S3 State 4k Municipal # Competency # E1608 Ins.Co. Architect /Engineer Peoples Gas Bonding Company n / a Mortgagor Permit Type(circle one): WORK DESCRIPTION Square Ft. 7 cpt WARNING TO OWNER: YOU MUST. RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAT 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 NOT I.CE 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. ture f owner and/or Condo President not a Co actor or Owner- Builder i g tur , Dat L - Date: 4/ Ut . Notary a t ( ► Faa ordheOndd,.: ,' 1 dent My Comtnissi�n • ** * * * FEES: PERMIT APPROVED: n/a • • `=, MY 20'.\ . '",UNI ti cc 384169 r * Address same Address Address MECHANICAL ROOFING PAVING PENCE SIGN No ry as My COmmi s s i K1sT14c L. Estimated Cost(value) $25Q.00 6 of), 0 • e S g,.uA . � 17i JOSE RIVERA MY COMMISSION # CC 790107 td tractor or • p e r -Bui 1 -: 1 - NOTARY F ?. Notary Services & Bonding Co. der * *• * * * * * * * ** e o RADON C.C.F '(D 0 NOTARY TOTAL DUE Fire Other Jo n P■CiDek3 5-fauLt •v N R/W EDP O C/ E0e PROP OPEN CUT S R/W 1 PROP 1/2" PL 50 T 2 BLK 1 PROP E/M x�r 2° SP PROP T /T, T /F, EFV, E/M PROP 2' PREFAB RISER 1. LOCATE AND PROTECT ALL UTILITIES IN AREA OF CONSTRUCTION. SUNSHINE #1 -800- 432 -4770 2. RESTORE ALL AREAS TO PRIOR CONDITIONS. 3. ALL CONSTRUCTION TO FOLLOW JURISDICTIONAL GOVERMENT .4N0 PGS STANDARDS. PEOPLES OAS PROPOSED 1/2" PL SVC 1350 NE 101ST STREET MIAIMI SHORES .10 : 395 AFE :: 010170000102 ATLAS: M -12 LOT : BLK: 1 SHEET: 1 OF 1 SCALE: NTS DRAWN BY.: C. H. NESB[TT DATE' 03 -15 -99 Date 3/M1 Job Address /„3.50 4 4/X /4/ 3L' Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant J Q, G D h S a 11 Owner's Address G O 4‘..0oA/ Phone 34S- 7.$ x..3.351 Qualifier /1/24/ fT 4, State #a�/,07/f/S3 Municipal # Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRIC PLUMB t► ' MECHANICAL ROOFING PAVING FENCE SIGN Square Ft. Estimated Cost (value) SGO• r3o 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in co ce with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Notary as t My Commission ExpvebAvE I.ANHAM NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC723471 MY COMMISSION EXP. MAR. 28,2002 FEES PE APPROVED: Zoning Building Mechanical Plumbing PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Address .3Z' See. / SS# - 74aVAhone,PW Competency # Ins. Co. II NI Electrical Master Permit # . ) 4 , 3 f / C.C.F. ^ 0' NOTARY — O J BOND TOTAL DUE Structural Engineer JACObs an/ 1350 ML" lb sr M/4Mi S h o2�s Cori reig. roit eousLr 0,28 -•5 f Res o 7 �- C c.,t. r/4-4' 7 OO Ccd / ,f/ /» — mss. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 I ( 1/ q / Job Address l' Ng 10154- Tax Folio I 1 3 2.47 0 2 3 - 0% 2_47 Legal Description Z- T3(ic Ol= M 1 P sYv1 j EI rU i1istorically Designated: Yes No / E�.Y 4p 2- e` l-.A.. 5 '5 - 'F) 8 3 .1.44Q lA' l t=om Owner/Lessee / Tenant �t��lel•l \./k) • 3= A�ob*ly 4 To t N Aft Master Permit # (1 Owner's Address 13 SO N ) i I S'f', Phone 3 " / 57 -. 3 .1- Contracting Co. ' M2--t tv P Ifs \ 1 , . Address 33C / 1) 1- - 6 7 $ Qualifier \ X ■ \,11 i p c - v w C...0%...)-71/41 SS# Phone 3 0 S - ‘ 0 , 6 - - ( - 0 / 6 State # q Zj f 7aZ-Municipa1# Competency # Ins. Co. Architect/Engineer amt.. IJ 1 G'1.1 Ilv t - loM i INC- Address 23 646..1-1 Aft s4. 66 , pc_.- Bonding Company //V 6 A— Address NI 4 Mortgagor 'IV/ 14- o Address 4\4)4-- Permit Type (circle one): BUILDING ELECTRICAL WORK DESCRIPTION C.).--1 MECHANICAL ROOFING PAVING FENCE SIGN 'F Pr1- r' O lM Square Ft. Estimated Cost (value) 1 004 • o" 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 OF 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 wil construction and zoning. Furthermore, I authorize the above -named contractor to do the wotk t er and/or Condo President Date Notary as to Owner and/or Congo President Date My Commission Expires: �L. `S 2AZ- gz�lcl2A rA cf) GLORIA SIB Ilo f NOTARY PUBLIC STATE OF FLORIDA ,,A) COMMISSION NO. CC678892 11,/ I orloMISSION EXP. SEPT 6, 2000 FEES: PERMIT RADON APPROVED: Zoning Building Mechanical Plumbing Signatur f C ntractor or Owner - Builder Date No : : to Contractor or Own My Co ssio Expires: el44 Michel Gonzalez * *My Commission CC717588 %,, Expires February 18, 2002 " done in compli with all appl C.C.F. OTARY BOND TOTAL DUE 7 V Electrical 41.sBi'l Date ooZ Structural Engineer s regulating ITEM BATH TUB UNIT .1 FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS ANO PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROU?O TANKS LAVATORY 1.-- OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER i MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 If TRANSPORTING ASSEMBLIES SINK. SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEWORARY WATER CLOSET MOTORS OVER 10- 25 If - FIRE SPRINKLER SYSTEMS IP NAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET 2 MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS • A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TR4OCRMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER- REPLACE _ GENERATORS TRANSFORMERS . LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIPING POOL OUTLETS CIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTI..RES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELO, 4' TILE/RES. _ _ VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION 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 (AN APPLICATION FOR BUILDING PERMIT RUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING n : Date 7 2_�--_ ° ffR 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. Permit No Owner's Name and Address__ tele Registered Architect and /or Engineer _v_____ —__ Employing Plumber's N in e r1 a;c t 4 i ...� ap1 . N c No.___.____.__._ Street. Location and Legal Desion Lot.- __..__ Block 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._ Size Septic Tank Feet of Drain Tile.__ Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. No.___J .,_ Street2_ i /f tij Subdivision Street Repairs No. of Stories. Type of Tank Capacity Gals. Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit Plum • g Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o$igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, 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 Notary Public, State of Florida 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 hire 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 worinnanship. CLOSETS BATH TUBE TUBS SHOWERS LAVA- TORIES $• SLOP SINKS LAUNDRY TUBE U 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 $WIM'G POOL CONTR. LIST CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING n : Date 7 2_�--_ ° ffR 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. Permit No Owner's Name and Address__ tele Registered Architect and /or Engineer _v_____ —__ Employing Plumber's N in e r1 a;c t 4 i ...� ap1 . N c No.___.____.__._ Street. Location and Legal Desion Lot.- __..__ Block 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._ Size Septic Tank Feet of Drain Tile.__ Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. No.___J .,_ Street2_ i /f tij Subdivision Street Repairs No. of Stories. Type of Tank Capacity Gals. Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit Plum • g Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o$igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, 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 Notary Public, State of Florida 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 hire 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 worinnanship. BUILDING ❑ ELECTRICAL PLUMBING ❑ ROOFING Owner of Building Architect Contractor or Builder Legal Lot II BI. Description Address of Building CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N° 14673 ❑ Work to be performed under this Permit Subdi- vision Value of Project $ DATE 195 Contractor's License No. Amt. of Permit $ 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 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. BY AUTHORITY BUILDING ❑ ELECTRICAL PLUMBING ❑ ROOFING Owner of Building MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N? 14822 ❑ Work to be performed under this Permit Architect Contractor or Builder Legal Lot II BI. Description Address of Building 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 or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. CONTRACTOR OR BUILDER Signed• Subdi- vision Value of Project $ . - DATE 195 Contractor's License No Amt. of Permit $ 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. BY AUTHORITY Permit No. T c 7,3 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subn Jf ed 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 wor Owner's Name and Address. Registered Architect and /or Engineer Employing Plumber's Name `- =-'-C - -- 19 ° No 3 0/0 Location and Legal Description Lot Block — -__- -l- - _ Subdivision!` . Street and Number where work is to be performed —No 4 jQ __ _____ Street l a / State work to be perfor med and purpose of building (By Floors) New Building Y / Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank___ Capacity Gals Feet of Drain Tile Nature of Water Su Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. Street _Dist. Feet of Tank or Drain Field from We1L Size of Soakage Pit -- — - - -��- (Signed) _ - - Street ).4C Date__ /3 /9.57 Plumbing Inspetor. The undersigned applicant for this building permit does hereby certify that he understan s nd 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. Master Plumber. STATE OF FLORIDA, 1 I '. • ISO } COUNTY OF DADE. ss. 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 far 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 fat') materials and /or workmanship. CLOBETe BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tues URINALS CAT BASIN FLOOR D DRAIN DRINKING F OU GypV �• � .L A_+ 74 ,,....,,, e3 T : Et / li b �jS TOTAL � N: /3 C ONTR. LIST 3 3 / CHECK �/� • S�b _ _ o / SEPTIC TANK SEWER CONK. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL Corm. LIST IET CHECK 1 'A3 ) 6D Permit No. T c 7,3 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith subn Jf ed 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 wor Owner's Name and Address. Registered Architect and /or Engineer Employing Plumber's Name `- =-'-C - -- 19 ° No 3 0/0 Location and Legal Description Lot Block — -__- -l- - _ Subdivision!` . Street and Number where work is to be performed —No 4 jQ __ _____ Street l a / State work to be perfor med and purpose of building (By Floors) New Building Y / Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank___ Capacity Gals Feet of Drain Tile Nature of Water Su Amount of Permit $ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT No. Street _Dist. Feet of Tank or Drain Field from We1L Size of Soakage Pit -- — - - -��- (Signed) _ - - Street ).4C Date__ /3 /9.57 Plumbing Inspetor. The undersigned applicant for this building permit does hereby certify that he understan s nd 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. Master Plumber. STATE OF FLORIDA, 1 I '. • ISO } COUNTY OF DADE. ss. 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 far 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 fat') materials and /or workmanship. • n et" I