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848 NE 100 St (10)Type Ins Name Address Company Phone # For Inspector: Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date _ Permit No. 59, � e . ' )° 37 Type Insp'n Permit No. Name Address Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 S Building Inspection Request �/ Date 7" Time • For Inspector: 1.//0 Approved Correction Re- Insp'n Fee 870. 4 ' fj 3 aite_ advt.) 3 o-r- OR s is Name & Date ELECTRICAL .1Y1.1: Minimum Fee Q.1.y . '1x,1,1,: Dryer QTY TYPE Outlet, Appliance Q.1.\ . Service Repair QTY A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch 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 TYPF. Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. 'I'vi'I: Refrigeration, Tons QTY. 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY •LYPI Soakage Pit Q'fY 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 DATE /(/(dlo4.• Zoning oP Electrical Mechanical Plumbing Fire Public Works Structural 1(114:2-.1-- Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ (X .ft. = x/1000 (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) O CONTRACTOR REGISTRATION (On File) -1 PERMIT FEES TOTAL $ 3 17 0 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 Page 2 IMPORTANT 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 PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF Print Name SEAL: Signature of O er ?e Signature of Notary ORIDA, COUNTY OF MIAMI -DADE GGnif�M�tC�p.�Ar/t Personally known Type of Identification Procce ,iYin 51Tekecou2 a ekday of Sworn to and subscribed before me this blic - State of Florida TIMOTHY H. CRUTCHFIELD My Comm Exp. 5/21/04 (�,[ p. �,, K C , C � 9 n 386660 h er 'W. deniVicaRnn 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: PERMIT APPLICATION Personally known OR, Produced Identification Type of Identification Produced: PROPERTY OWNER Name li i) 6q r at5CtI \ / Address t .— v n?Ifji'li 5e,Wre t L 35 iif Home Telephone 5 5-_ 7 s-7 _ c 9 7' /C . 3 0 7 00 Business Telephone - 372- Fax 305 -372 - s'y a � TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'1 Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address' 7 O /V f / DO 51 Address Apt Folio Number Lot Subdivision Current Use of Property Proposed Use of Property Tenant Information Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Block PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other PB PG • �,� �; Zoning QCs) 6 /� t in L Square Feet / r o v Units Floors 3 ft ill r� ° -1 -Value of Work , �( 1(7� Bldg Value a Tax Assessed/Appraised Value PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. MI' 5.or eS & 35/31 City ,,.Description of Work yr I t tf VF( �`V I& J 4--wri LK w41 ct 8>9c4 PA-770' Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax x CONTRACTOR Name cal License No. Address Telephone Fax Qualifier Name PERMIT APPLICATION State Zip Linear Feet Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -1993 Printed: 11 /19/2002 Applicant: DAVID Owner: SCHAFMEISTER JOB ADDRESS: 848 NE 100 Contractor Local Phone: Parcel # 1132060340030 This Permit is granted to the contractor or builder named above to construct the buil ordinances pertaining thereto and with the understanding that the work will be perform and approved by the proper municipal authorities. This Permit may be revoked at any authorization. A further condition upon which this permit is granted is the understandir ordinances and regulations pertaining to the work covered hereby whether shown on tt by his agents, servants or employees. • e< Signed: (INSPECTOR) In consideration of the issuance to me of this permit, I agree to perform the work cov with the plans, drawings, statements or specifications submitted to the proper authoritil myself, my agent, servants or employes. Signed Building Permit (Contractor or Buil BATCHELDER CAROL ST Contractor's Address: Legal Description: MIAMI SHORES SEC 8 PB 14 -33 LOT 5 & W1/2 LOT 4 BLK 169 LOT SIZE Fees: Description Amount FEE2002 -6569 Building Permit Application Fee $60.00 FEE2002 -6570 Buildier's Bond $300.00 FEE2002 -6571 CCF $1.20 Total Fees: $361.20 Total Fees: $361.20 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 5/18/2003 Construction Value: $2,000.00 Work: BRICK PAVERS IN DRIVEWAY & WALKWAY & BACK PATIO 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. MILLY S. BATCHELDER 848 NE 100TH ST. MIAMI SHORES, FL 33138 -2512 DATE PAY TO THEN t w _ 4\ ICS V �/�.� -�`-' 1 $�!7/ :1,Pg ORDER OF aaa W`���" ~Y./ / — 7 Cy 8 W 1 Washington Mutual NOTES Washington Mutual Bank. FA Surfside Financial Center 1744 9556 Hardin Avenue 1.80 0 Sull��h +CFJ..�315� \ 24 hour Customer Sorts Page 1 of 1 63- 8413/2670 8312889261 --1: 2E, ma 4 L; L ; Lin ?RAE/ nu' Lio f1RL 845 0 g - • • NE 100 STREET 19' Asphalt 12' Asphalt Parkway . . . . . • 5.5 Con. Walk f....1-......1 .00y# a Af) i F P N D ia - - NF.T i . 4 i ri, 4` • A! i H i P orch 11 18•14,...-, ..----,,,. W I , :4- I t1 70 it '. p 12 15 [ff*. O &IE STORY RESIDENCE # 848 CBS PL 2600' 1 1122' U1011111 A "IC AS •1111101011EASEIRDEE A/C 411110011011 Al" •0114AL, OUL •OLOPC RA WPM WV • .1110Woccuerr mow lel AMMO S,LPO 4ENTERILIG CS •OLINRE1111.00t CRS. .010011111LORN mum 0.9 600111011 cu. •POIN LIEIR MICE CMG ottomorwri OCR 60110O CO4J0111100R01 D S VIEEMP161 01 .01101106111 12.85' 0 ass 18 75' 5. 1/ 0 175 FN . ic I 780' s 1 ¶ 6,11,1 • si '5 1 1280' 141 cL j RIK • FND.I.P. 112 c . 8.50' I 2' .fl C�ncI 5 • sw,t , ■ g 1 8 . cocf• 'DLL: 7 g 111 t 2 .so° ; .. Fence „ . ... it " FND.I P9a. morma 4.9 ; IP 177' 15,11.LEY • 9' Asphalt 2 95' PROPERTY AlpRE.SS: 848 NE 100 STREET MIAMI SHORES, FLORIDA OA. ARUN AXE M.B. "1131111DLARC6 FAAEMENT PVC Joon OP CO•••041.16091 EL. ARS/ARCM PRD .10.1111 0101 9 1. OMER POLE EP ADM Or PAVEVEN1 111 44All I TM • OLIN overemer 111,6111101 MON EW AWE Of WATER Wa OM atallaP PAM .PMISPIIT 911617 "ANEW .011 WOAD 9 "DIAL CO 4 00E44 04 ,010049111 99. 4I999 RED. AIM 0 9.9 .OPECIAL WARD IOW 6 DADE s" "13611-06VIAY 9 PAL. .FLOPIDA POWER 6 UDR! P .PLAT SA! 4cartIlliei Int nueecte 411090101011E110 (A99910 PO •PLRE WOK 1119.9 "Ter 10011 EIDO CM Mr7 PIT. 441116SEC11011 PER Okiii erial COUNTY R1COR99 SD NO ARNOW' ION 1P. "ON PIPE PD. 61 or cummunt ow A1011 WAR '9. "00 ROD PIP .peelerseer coroeoL POW le •TOP OP IWIlt Le AMMO° OURNOte 9.1 00011 OP TA/0MM *9. .unLer RAIIIMMIT L R. 6U019611E0 suavireapt "OPERTE UNE *.0 4111111111121101011 16. .4(01(59.0 . W.O.e. 61 OP MOM" W *9000941C1 KM 61" KOLE 11* P. .1/1111ReCE • .991179.9. 4999.9 NORTH ARROW ORIENTATION, FIELD DETERMINED REARMS MO IN 0103 ERNIVES APE PANED ON ELEIVATIONRI APR TINE TO N.G.V.0 09 4919. NOT VAUD VIGHOUT THE SIGNATURE AND THE ORYNNAL RAKED SEAL OE A FLORIO* UCEN590 SURVEYOR 9440 MAPREFt IGULK D. STUMM PAW PEGISTEREO LAM summon AND YAPPER No. 01,9 WWI OM DIP eLORICIA ONLY 111^ 1, 1.1aRT OP I% erg PrODILY 994MM *Ps 10401404. NO RPRI.Anak CfreFaVae lea FIRM MOS lama T. jizs rovoir I MS- Iw' 1P.W411 rtg . rap ALL COUNTY SURVEYORS BOUNDARY SURVEY FOR PROFES8IOt4AL SURVEYORS AND MAPPERS Liam. Number 8877 PHONE: (954) 777-4747 FAX: (954) 777-2707 5950 W. OAKLAND PK. SLVD. • SUITE 108 • LAUDERHILL, R. 33313 AM/ DAVID BATCHELDEit Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address � Nfr f p� S4- Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant V • .J , SC M g-tS j \ /g , Master Permit # qa Owner's Address g 1)S N. F., /CO 6t Phone ?5 7-5 7g 3S6/O02 /. e Contracting Co. ©IA )N &2 Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN f!//, c / (lo evEzi dcb t (9 iar rku ,1301-7t5vI) 1 Ai.rGeve Square Ft. Estimated Cost (value) WORK DESCRIPTION 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 owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: Signature of CI ctor or Owner -Bui • e Notary as to Contractor or Owner - Builder My ODU rPIOIAL NOTARY DEAL <- SANDRA CH TIEL conr.nssloa R1urinE;R CC401 261 -EXP. ea v corar�ISSIOC� ���' �� AuKs1, 9l qalL3 FEES: PERMIT 612. RADON C.C.F. y t. NOTARY 6 BOND No /o TOTAL DUE ate Da te 1/e4 APPROVED: Zoning Building 2"5 6) 1) / b Electrical Mechanical Plumbing Engineering t J i o,„ 1 „ 95e , a p a r� .ovoPg,g 1 ,rat/ Al Picepo,SV ff (!_j „--4— 60fra—Cle • Date 1 2 . AB:1 Job Address CM? AI•E, Se Legal Description j¥ 14 "/ /4/9 ✓,�... olOpi. / Lessee / Tenant /144A ` \I ' .e4f 1-1P/77 ' S 44? , Master Permit „ /O-/ � � Owner's Address Contracting Co. e11U/A Qualifier SS# ( ' „ Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION p�ip lr4 / lO/ 2776- p &) 64)4? g �g �> � CE anwT s4f4 -,8 Co rv/e:t4i Yu Square Ft. Estimated Cost(value) oCQOe 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 authori _ the above -named contractor to do the work stated. Signature o Date: / ��9, ary as to Owner an My Commission Expires ** * * ** * * * * * * FEES: PERMIT V' RADON C.C.F. Fire APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE er and /or Condo President Signature of Contractor or Owner- Builder Date: ' 4.0. JOSEPHINE IMMO ( , .Notar Public S sigAYISMslittifit Pod 30.1 '• . ;: � No. CC197545 Mechanical Plumbing Tax Polia 3M6' J 41 66'YO g Phone ?5 7 9 7 s Address Notary as to Contractor or Owner- Builder My Commission Expires: * * ** NOTARY .S r e TOTAL DUE 1 4 / 3/ 46 Other Electrical Engineering_ • i• ' Name and address of licensed contractor STATE OF FLORIDA COUNTY OF DADE. J SS. FcF) (qa„10 25 5G,S7 APPLICATION FOR BUILDING PERMIT a y MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT 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 the work. Date / / 91'" 197 Owner's Name and Address 4/ dil `' 49A7M S / ' ` No. 8 Street •cr • ./.0© Registered Architect and/or Engineer Location and . le e g 1 description of lot to be built on: Q �� ' O Q / 3 Lot ( *W k I Block /! Subdivision _���! - / l Y oz a‘ � 0 3 " Street and Number where work is to be done p 41 Ad F • /00 State work to be done and pu of building (by floors). state exterior colors (submit samples) S 9 /D �T e yt.30 �f� �uS� l,/n cis CPp 1 f L�¢wn i7' / ` • A -Ir un L� /3 and for other purpose. f New Building Remodeling Addition Repairs No of Stories To be constructed of Kind of foundation Roof Covering Amount of Permit S Estimated Total cost of improvements S 3fi0 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor 1 hereby submit all 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 obligatons 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 subcontractors 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 ploy only such subcontractors. on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks (Signed) Before me, the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments. personally appeared 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. Permit No. 7.4017/0 Date Read, Sworn to and Subscribed before me. Disapproved Date (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of 525.00 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 525.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials andlor workmanship. Notary Public. State of Florida to me well known. ",.... -".• <,- ", r ' --,--', 4 ",—.: .ftfg...... :-,s. -.....; - '. 3••• . ...Z.t.4. - +: , .. , - 4 , F , 7 , 4-•.- i.....-• ......" - , -....: -,‘ . ----li.... -.4-.1., :......::.. ..,. , . , • -- - . . . • . . .. . .