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301 NE 101 St (14)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE - Date / - /8-9‘ /p Job Address X'/ /V M/ I- Tax Folio Legal Description Owner/Lessee / Tenant Owner's Address Contracting Co. ,k%'4' ?lea L Qualifier 2 /u) / (- 1 a Z,y SS# - -� hone gw 4j /41 State # t ®/2(//99 Municipal # Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Le i 'G _ - / rD re-A G e- 77Q/3/ 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. e of owne Notary as to My Commis APPROVED: Zoning Mechanical wner and/or ion Expires: / 6/e D/ 111 /D /S d/o ' o President FEES: PERMIT / ®' '00 RADON 7 Date L l oos COPAN NUMBER O Q CC338288 �\ ((* OF F10 My COMMISSION EXP. _... JAN. 311998 Historically Designated: Yes No Master Permit # Phone Address Competency # Ins. Co. Address Address Address Estimated Cost (value) 1 Building Signature of Contractor or Owner- uilder D . ' L gm'iff,wff,riiik,44 Y/F4 Notary as to Contractor I ') er !�'/ SE L i ate PATRICIA BRIGGS My Commission Expir =. c , 3 , Co ; �Qiv.Y. <.tOid NUAISER t ' `r' CC 7 - cr V MY COP «ibiiSSION EXP. OF FAO C.C.F. NOTARY TOTAL DUE /Da Electrica JAN. 31,1998 Plumbing Engineering 1 _.5:6' -Z .l -• DRIP LOOP TO BE 1 0' AFG (MIN) . _J r.7; CLAMP f 2OOA (METER 2' ABOVE RDDF FINTSHEB GRADE sumac NEACHING - PL Tic 4G r/c rE 1 MAIN CB PANEL WO' H IN DEPTH 1 MO SO KING \\I TEAR IMP CLAeiP SAT" x e- GRauNIII REM Qii?d SUB CB PANEL SIG NOT kl�tk UK r1h 1 Conductor size 1,/ 1 Conduit stze Conduit - yp€ Thru Ground were sr e_ } MAIN. DI�\11lECT Rating Amps of Ft.9 Man I '( BY Sub Breakers Amps SUB FEEDER Nes- - ExiS ting� Type Size * W0. N 6av COYMISSWN EXP. Bond e_��. INSIDE PANEL Rating " "6L Amps Bond Buss Tes No Location /A) e PER S.F.B.C, 4505.2(B) CONTRA_CTOR jLCcNSE. # i" (Tf Tr' A l riT\ ; T ntN 1 Lam a/cW05 3 w / SO. FT 0204 ‘. KW. REFRIGERATOR / 5 Kw. APPUAIICES KW. DISHWASHER / ' g K.YL GARBAGE DISPOSAL / K11. ` ICRO AYE KW. CLERKS WASHER `I 5 KW. DRYER KW. . RANGE - KW. 111001 HEATER 5 KW. WEN K.W. FREEZER KW. MASK COMPACTOR K.W. WAAGE DOOR MOTOR. K ' ' JACUZZI K.11. ,Arum BOOSTER KTR. K.W. IRONING BOARD /a KW. POOL EOUIPWENT KW. SPRINKLER PLUP / g KWk. LANDSCAPE LEWES KYt. SPATE CAMP KW. KW. /�I� TOTAL CONNECTED LOAD MGT 10 KW. • 100 1O. Krr. TaT 11 40 s , sa X h/�T/dd; 9,01 KN. DEMAND LOAD K.w. , 240 V. s //5 xw. (,Ole Ai do,ca /DlS MOODY ELECTRIC, INC. 669 N.W. 90 STREET MIAMI, FL 33150-2166 TEL: (305) 891-1374 FAX: (305) 758-2000 C 6T Oct b--) a 06- 1b Vi IfUJ actitzo ITEM BATH TUB UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIN)) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPA.IR/b¢TER CHANGE / .4i0 REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE (ROB TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSLRE VESSELS CLOTHES WASHER MOTORS 0— 1 HP STEAM BOILERS SHOWER 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 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8— 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10— 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR .CONDITIONERS 3 2/ ' A/C UNIT STRIP HEATER / 59 FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER —NEW INST. GENERATORS TRANSFORMERS HEATER — REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER —WELL SPECIAL PURPOSE OUTLETS COMMERCIAL SWIMMING POOL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY —SEWER SIGN TIME CLOCK UTILITY —WATER F I XTI.. ES SEPTIC TANK ANTENNA TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION , SOAKAGE PIT CU. FT. CATCH BASIN / '/'A / 7 DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) 3AS PIPING (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 ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL U SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO, LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. EIACE H ATER STRIP HEATER TOTAL T 7 W ENT. SW. DIST. CAD. SERVICE TEMP. SERVICE PERM. M OTORS 0.1 HP M OTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit No APPLICATION FOR ELECTRICAL PERMIT 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 �/� 1-7 ' /k r No 3D " i ° 1 1.' Street MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Date...... 7/.1.1. Registered Architect and /or Engineer 1 /� Employing Electrician's Name. v +".4�" E�e c/,:cC .T c . No . 7 A../E. Street 7 S Location and Legal Description Lot Z / 3 "at ki 1 2- / Block ' If Subdivision " `: ' 1.4 1 Street and Number where work is to be performed —No '3 ( Street State work to be performed and purpose of building (By Floors) R &t e e � ! r ° 44.9/1 a i Repairs No. of Stories New Building Remodeling N_A'. /o / &:' f • Addition Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation -- Conduit Tubing 7 B.X.L Metal Moulding S® Amount of Permit $ STATE OF FLORIDA, ‘l COUNTY OF DADE. 55. (Signed) - (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and ace s his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws 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 notice or notices as are required by the Act. The undersigned agrees to employ only, such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Electrician. 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, and 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 inspection, or faulty materials and /or workmanship. BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description. Address of Building Lot MIAMI SHORES VILLAGE, FLORIDA lifi PERMIT N° 9177 Work to be performed under this Permit r'. 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 statementsor 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. CONTRACTOR OR BUILDER Bl. Subdi- vision Value of Project $ DATE Amt. of Permit $ j/ BY AUTHORITY 195' Contractor's License No. L � BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA DATE /lip' J 19 Contractor's License No. PERMIT N° 8746 Work to be performed under this Permit Subdi- vision 4 CONTRACTOR OR BUILDER BY AUTHORITY Legal Lot ! .' ' i C / . 1 Bl. � , Description - , Address of ,,..- ) f'` Value of Amt. of / Building' r ' / <•- `- f �//' Project Pe rmit / •� This permit is granted to the contractor or builder named abo e to construct the building or to install the equipment or device described in the appli- cation 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 ate 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 drawpings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. • . • --- Signed INSPECTOR v / In consideration of the issuance to me of this permit I agree to perform Ihaovo 4 covered hereunder in compliance with all ord lances 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. APPLICATION FOR ELECTRICAL PERMIT Permit No._____ ___ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sil6mitted 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_ Y _' >''' ` No Street Registered Architect and /or Engineer //'�� __ Employing Electrician's Name e - i-..,___6 '! * � ' % / .' Location and Legal Description Lot / j ' Street and Number where work is to be performed—No. _11 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No. 3 71 / /VC Street___ Block 24K Subdivision Street__ ____ -Z D, /yl y .�� State work to be performed -and purpose of building (By Floors) New Building________ Remodeling_ Addition_______ Repairs No. of Stories Service Overhead Underground Size Feeders Conduit Type of Installation— Conduit_ ......... ____ ___Tubing_________________ Metal Moulding _Main Sw ._— _— _________________Amps.____ Main Fuses Amps ( Signed) — 7 ` —— Electricalpector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer f labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, a d has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in he work to be performed under this permit; and will post or cause to be p osted for inspe io 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 - contract rs, on work to be perfo i 1 • : r this permit, as are licensed by Miami Shores Village. Amount of Permit $ ss. Date__ Master Electrician. STATE OF FLORIDA, 1 COUNTY OF DADE. I Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appearecL ____________ 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, and 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 inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK APPLICATION FOR ELECTRICAL PERMIT Permit No._____ ___ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sil6mitted 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_ Y _' >''' ` No Street Registered Architect and /or Engineer //'�� __ Employing Electrician's Name e - i-..,___6 '! * � ' % / .' Location and Legal Description Lot / j ' Street and Number where work is to be performed—No. _11 MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT No. 3 71 / /VC Street___ Block 24K Subdivision Street__ ____ -Z D, /yl y .�� State work to be performed -and purpose of building (By Floors) New Building________ Remodeling_ Addition_______ Repairs No. of Stories Service Overhead Underground Size Feeders Conduit Type of Installation— Conduit_ ......... ____ ___Tubing_________________ Metal Moulding _Main Sw ._— _— _________________Amps.____ Main Fuses Amps ( Signed) — 7 ` —— Electricalpector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer f labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, a d has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in he work to be performed under this permit; and will post or cause to be p osted for inspe io 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 - contract rs, on work to be perfo i 1 • : r this permit, as are licensed by Miami Shores Village. Amount of Permit $ ss. Date__ Master Electrician. STATE OF FLORIDA, 1 COUNTY OF DADE. I Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appearecL ____________ 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, and 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 inspection, or faulty materials and /or workmanship. STATE OF FLORIDA, COUNTY OF DADE. } APPLICATION FOR ELECTRICAL PERMIT Permit Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s mitt for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi mi 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_t_ ____ Registered Architect and /or Engineer Employing Electrician's Name____ _______ ____________ / y '" Location and Legal Description Lot '� i5 ''I' ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT — — No _ _----- ----- - -__�_ _Street- --- --------- _______ -- 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__________ No. - -- — 0] -- N _ e1 _Block 3 A Subdivision - - - - -- - -- - - - - -- 3 . i�� __Street _ - - -� —/ t -ttit _ _Repairs__ Date_ 6/ No. of Stories !� .I Overhead ( ® Amps Service F0t Size Feeders Conduit__ _�__ ___Main Sw._____� Main Fuses__1 / ® �___ Type of Installation— Conduit___ =_____ Tubing____ r- --B X L Metal Moulding�_�- _-- _-- _-- �____ -___ _ — — �________—_ -- Amount of Permit $___f S - v ( Signer :ry r __ _ Electrical Inspector. The undersigned applicant for this building permit does hereby certify that a derstands and accepts his ob ' tions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, mpi •d General Laws of Florid rmanent Supplement, and has complied with the provisions thereof, and will require similar compliant, fro: all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be p osted for inspectio : 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 - contractor on work to be perf ed under this permit, as are licensed by Miami Shores Village. Master Electrician. 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, and 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 inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONT / ___/__ / CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0 -1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST / CHECK T STATE OF FLORIDA, COUNTY OF DADE. } APPLICATION FOR ELECTRICAL PERMIT Permit Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s mitt for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi mi 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_t_ ____ Registered Architect and /or Engineer Employing Electrician's Name____ _______ ____________ / y '" Location and Legal Description Lot '� i5 ''I' ss. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT — — No _ _----- ----- - -__�_ _Street- --- --------- _______ -- 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__________ No. - -- — 0] -- N _ e1 _Block 3 A Subdivision - - - - -- - -- - - - - -- 3 . i�� __Street _ - - -� —/ t -ttit _ _Repairs__ Date_ 6/ No. of Stories !� .I Overhead ( ® Amps Service F0t Size Feeders Conduit__ _�__ ___Main Sw._____� Main Fuses__1 / ® �___ Type of Installation— Conduit___ =_____ Tubing____ r- --B X L Metal Moulding�_�- _-- _-- _-- �____ -___ _ — — �________—_ -- Amount of Permit $___f S - v ( Signer :ry r __ _ Electrical Inspector. The undersigned applicant for this building permit does hereby certify that a derstands and accepts his ob ' tions as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, mpi •d General Laws of Florid rmanent Supplement, and has complied with the provisions thereof, and will require similar compliant, fro: all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be p osted for inspectio : 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 - contractor on work to be perf ed under this permit, as are licensed by Miami Shores Village. Master Electrician. 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, and 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 inspection, or faulty materials and /or workmanship.