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ELECTRICAL PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date..3 5 — o/ Job Address 17/ /ft /0 / S / Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant eve Y/ :Stu 4. r.7�f Owner's Address y7/ /f C. /0/ -S ! / Contracting Co. Cei - at-i 6- ";7C C Address /"7 6 i�4/ SC C /�' Qualifier 4...)' « & State # 69€0 2 S v 3 i Municipal # Competency # Ins. Co. Architect/Engineer Address __ Bonding Company Ai ' 42 -4 . Mortgagor Square Ft. Notary My Co APPROVED: Zoning Mechanical Permit Type (circle one): BUILDING ECTRICAL ,UMBINC WORK DESCRIPTION r V C c t/ WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENC PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU 1 OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMI Application is hereby made to obtain a permit to do work and installation as indicated will be performed to meet the standards of all laws regulating constriction in this juri PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. e for going information is accurate and e the above -named contractor to c� O ' 5 AFFIDAVIT: I certify cons do d zoning. Furth esident__ Da Sign Building Date ay. / a2 Esti] Plumbing 0 — OFRCIAL NOTARY SEAL COMMISSION NO. CC962633 MY COMMISSION EXP. AUG. 21,2004 n FEES: PERMIT ' RADON C.C.F. IQ 7 ss / 31�'��'•��iy �/ My Phone Address Company Phone # Master Permit # STO$ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request v�- Date Type Insp'n T L il-egai4 Permit No. Name ) 1.5 �a3 Inspection Date c9// Approved Correction ❑ /v r L'90.6vs Re -Insp' n Fee ❑ •1 ITEM 3ATH TUB . UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE 3IDET LIGHT OUTLETS CENTRAL HEATING )ISHWASHER RECEPTACLES A/C (WIND) )ISPOSAL SERVICE TEMPORARY A/C (CENTRAL) )R INKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK LOOR DRAIN SERVICE REPAIRAETER CHANGE REFRIGERATION :CREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING NTERCEPTOR RANGE TOP UNDERGROUND TANKS .AVATORY OVEN ABOVE GROUND TANKS .AUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS :LOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS 'R 'INK, MOTORS OVER 1- 3 HP HOT WATER BOILERS POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION INK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES INK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS EMPORARY WATER CLOSET MOTCRS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS RINAL MOTORS OVER 25-100 HP COOLING TOWERS ATER CLOSET MOTORS OVER 100 HP VIOLATION NOIRECT WASTES A/C WINDOW REINSPECTION ATER SUPPLY TO: AIR CONDITIONERS 1 . A/C UNIT STRIP HEATER FIRE SP RINKLER GENERATORS TRANSFORMERS . HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES WER CONNECTIONS SIGN TRANSFORMERS ILITY -SEWER • SIGN TIME CLOCK I L I TY -WATER FIXTURES ?TIC TANK ANTENNA -• LAY TELEVISION OUTLETS UINFIELO, 4' TILE/RES. VIOLATION P & ABANDON SEPTIC TANK REINSPECTION VAGE PIT CU. FT. iCH BASIN O1ARGE WELL 4ESTIC WELL :A DRAIN • IF INLET - AR WATER HEATER E STANDPIPE L PIPING N SPRINKLER SYSTEM RANGE . ER SET (GAS) PIPING 1 ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED_AOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL APPLICATION FOR ELECTRICAL PERMIT Permit No �j'� 0 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s itted 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 Registered Architect and /or J' ine -r Employing Electrician's' Na tom./. Amount of Permit $ 55. My Commission Expires MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Location and Legal Description Lot Block No Street and Number where work is to be performed —No `?:. ..1 ( E, /0 (Signed) (Signed) X7 No � Date Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation Conduit Tubing B.X.L Metal Moulding The undersigned applicant for this building permit does hereby certify that he understands and accepts his o labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida has complied with the provisions thereof, and will • require similar compliance from all contractors or sub-contra '! 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. Street Street 7 at G Subdivision /4 ectrical Inspector. ons as an employer of nent Supplement, and STATE OF FLORIDA, l COUNTY OF DADE. I 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. Notary Public, State of Florida Master Electrician. 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 ---W- PLUG RECE'P'T'S FIXTURES N O. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER H EATER W. HEAT. CONN. SPACE H ATER STRIP HEATER TOTAL CONTR. LIST / y / }- ���ttt 9 CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS I.S HP N EON TRANS. RADIO TOTAL CONTR. LIST • CHECK APPLICATION FOR ELECTRICAL PERMIT Permit No �j'� 0 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith s itted 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 Registered Architect and /or J' ine -r Employing Electrician's' Na tom./. Amount of Permit $ 55. My Commission Expires MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT Location and Legal Description Lot Block No Street and Number where work is to be performed —No `?:. ..1 ( E, /0 (Signed) (Signed) X7 No � Date Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation Conduit Tubing B.X.L Metal Moulding The undersigned applicant for this building permit does hereby certify that he understands and accepts his o labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida has complied with the provisions thereof, and will • require similar compliance from all contractors or sub-contra '! 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. Street Street 7 at G Subdivision /4 ectrical Inspector. ons as an employer of nent Supplement, and STATE OF FLORIDA, l COUNTY OF DADE. I 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. Notary Public, State of Florida Master Electrician. 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. $,r Permit No MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT ‘0 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 comp ed with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of wo Owner's Name and Address Registered Architect and /or Engineer. Employing Electrician's Name Lgcation and Legal Description Lot Block Street and Number where work is to be performed —No Service Overhead Size Feeders Underground Amount of Permit $ has complied with the provisions thereof, and will require similar compliance from work to be performed under this permit; and will post or cause to be posted f or as are required by the Act. The undersigned agrees to employ only such sub- licensed by Miami Shores Village. 58. My Commission Expires (Signed) (Signe 4 !. No 11 Street.., t / ®/ ' nspection o ontractors, o Date Street Subd' • ion Str .. State work to be performed and purpose of building (By Floors) ' ~:4q:1– �" ` 4 . -e New Building Remodeling Addition Repairs Conduit Main Sw Amps.. L Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding Ele • 'cal 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 Permanent Supplement, and o. of Stories actors or subcontractors employed by him in the the site of the work su h public no ' -, notices work to be pesforme under this •ermi as are Notary Public, State of Florida Master Electrician. STATE OF FLORIDA, } COUNTY OF DADE. 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. 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 REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. H EAT. CONN. ACE H ATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. D18T. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.8 HP N EON RADIO TRANS. TOTAL CONTR. LIST 4 -2., ® / Hi �]�/ / /� '4. /. . _�.� ji i _ S c - 4 I. 5 CHECK $,r Permit No MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT ‘0 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 comp ed with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of wo Owner's Name and Address Registered Architect and /or Engineer. Employing Electrician's Name Lgcation and Legal Description Lot Block Street and Number where work is to be performed —No Service Overhead Size Feeders Underground Amount of Permit $ has complied with the provisions thereof, and will require similar compliance from work to be performed under this permit; and will post or cause to be posted f or as are required by the Act. The undersigned agrees to employ only such sub- licensed by Miami Shores Village. 58. My Commission Expires (Signed) (Signe 4 !. No 11 Street.., t / ®/ ' nspection o ontractors, o Date Street Subd' • ion Str .. State work to be performed and purpose of building (By Floors) ' ~:4q:1– �" ` 4 . -e New Building Remodeling Addition Repairs Conduit Main Sw Amps.. L Main Fuses Amps Type of Installation— Conduit Tubing B.X.L Metal Moulding Ele • 'cal 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 Permanent Supplement, and o. of Stories actors or subcontractors employed by him in the the site of the work su h public no ' -, notices work to be pesforme under this •ermi as are Notary Public, State of Florida Master Electrician. STATE OF FLORIDA, } COUNTY OF DADE. 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. 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. Permit No„ ±?_k 2 4Q__ Application is hereby made for the approval structure herein described. This application is and all provisions of the Laws of the State of of Miami Shores Village shall be complied building during progress of work. Owner's Name and Address ___. Registered Architect and /or E Employing Electrician's Name Location and Legal Description 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 r/ 1 , Amount of Permit $__ - -_- APPLICATION FOR ELECTRICAL PERMIT ss. My Commission Expires MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT of the detailed statement of the plans and specifications herewith submitted for the building or other made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division with, whether herein specified or not. A copy of approved plans and specifications must be kept at 4 ` $ yy • L_ ' No.______�__1� __ —_ Street I/ L671 s � r -------------------- No.__ i/ (Signed) (Signed) Date_ _w_.____. Subdiivision__ __________ 71 Street Repairs____________________,___ No. of Stories Service Overhead Size Feeders Conduit.___��___ .____ `� �� ___ Main Sw __ Amps. ___ Main Fuses___ Amps. Underground p Type of Installation— Conduit Tubing B.X.L Metal Moulding Notary Public. State of Florida Electrical Inspector. ‘keK;ce`';/ C l Master Electrican. A ,44, 4 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 under signed agrees to employ only such sub - contractors, o w5rk be performed under this permit, as are licensed by Miami Shores 'Village. STATE OF FLORIDA, COUNTY OF DADE. the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments, personally Before me, appeared to me well known, and who, being by me first duly sworn. upon oath deposes and says that he is of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. OTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty it eIC erials 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 L / .2-- i CHECK ` / ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0-1 HP MOTORS 1 -5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK . Permit No„ ±?_k 2 4Q__ Application is hereby made for the approval structure herein described. This application is and all provisions of the Laws of the State of of Miami Shores Village shall be complied building during progress of work. Owner's Name and Address ___. Registered Architect and /or E Employing Electrician's Name Location and Legal Description 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 r/ 1 , Amount of Permit $__ - -_- APPLICATION FOR ELECTRICAL PERMIT ss. My Commission Expires MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT of the detailed statement of the plans and specifications herewith submitted for the building or other made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division with, whether herein specified or not. A copy of approved plans and specifications must be kept at 4 ` $ yy • L_ ' No.______�__1� __ —_ Street I/ L671 s � r -------------------- No.__ i/ (Signed) (Signed) Date_ _w_.____. Subdiivision__ __________ 71 Street Repairs____________________,___ No. of Stories Service Overhead Size Feeders Conduit.___��___ .____ `� �� ___ Main Sw __ Amps. ___ Main Fuses___ Amps. Underground p Type of Installation— Conduit Tubing B.X.L Metal Moulding Notary Public. State of Florida Electrical Inspector. ‘keK;ce`';/ C l Master Electrican. A ,44, 4 The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has 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 under signed agrees to employ only such sub - contractors, o w5rk be performed under this permit, as are licensed by Miami Shores 'Village. STATE OF FLORIDA, COUNTY OF DADE. the undersigned authority, a notary public. duly authorized to administer oaths and take acknowledgments, personally Before me, appeared to me well known, and who, being by me first duly sworn. upon oath deposes and says that he is of the above described construction, that he has carefully read the foregoing application, and that be did sign the same, and that all facts therein by him stated are true. OTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty it eIC erials and /or workmanship. BUILDING ELECTRICAL PLUMBING ❑ ROOFING ❑ Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building PERMIT N? 15696 Work to be performed under this Permit », X 4 CONTRACTOR 0 Bitl+ILDER MIAMI SHORES VILLAGE, FLORIDA DATE 195 1 Subdi- vision Value of Project $ ! ` ' J t. BY Contractor's License No Amt. of Permit $ AUTHORITY 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 rev4'ked 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. i cL ) ,...rr.}0..,, Signed: v* ; x . BY A..J c <,. t 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. Miami Shores Village, Fla. OWNER INSPECTION TIME READY PERMIT NO. CONTRACTOR TELEPHONE NO. ,!/G a,4 7 ADDRESS 4 /W/O/ s/ t /n • 9 -C INSPECTOR J DATE 3 --,720-0/ DATE //r29hePj MIAMI SHORES VILLA �wr BUILDING INSPECTION DEPARTM BUILDING INSPECTION DEPARTM APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Date 3 , 19 4 0 Owner's Name and Address f Registered Architect and /or Engineer Name and address of licensed contractor -.1 �1 �`^"( V _"'' / ?act Location and legal description of lot to be built on: (/ Lot Block Subdivision Street and Number where work is to be done VP/ 0 1 .410r IC State work to be done and purpose of building (by floors )3 Vim' /" ^. . , r—.ot 1 0- otoi.ex °' ^ - and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering fy s 9. , Estimated Total cost of improvements $ ld D 0 . Amount of Permit $ of . Zone cubage required plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public 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. Remarks (Signed) �_ �+ s STATE OF FLORIDA, V - ss. COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared 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 stat are true. Permit No '� R � Date ^ `t' - L Read, Sworn to and Subscribed before me. Disapproved Dat ( Signed) IL-If � e / s .Q'' Building Insp or My Commission Expires Notary Public, State of Florida ANNING BOARD DATE Chairman Member Member Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary y improper notice for inspection or faulty materials and /or workmanship. •