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504 NE 101 St (10)Qualifier Date 3/06/96 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 504 NE 101 STREET Legal Description Historically Designated: Yes No Owner/Lessee / Tenant WILLIAMS Owner's Address 504 NE 101 STREET, MIAMI SHRES 33138 Phone 315 -5563 Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET, MIAMI 33168 T)FNNTS NFVTT,T.F SS# Phone 754 -3375 State # 025836 -8 Municipal # Competency # 12842 Ins. Co. TRAVELERS /ESIF Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): METIMEINGXEIECCIRPLIMIL PLUMBING MEKTIMINICKILX2XMCIIIMEMINUXIKIWOEOCNICIil WORK DESCRIPTION INSTALL DRAINFEILD Square Ft. 400 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 js: ork will be done in compliance with all applicable to do •rk stated. laws regulating construction and zoning. Furthermore, I authorize the above -named Signa e of owner and/or Condo President Date � / e" 5-6 1.-9C, Not. • t.. can and/or o do ' res' ent Date My ion Expires: �,tittttsSttttttttt�tS�St�S��,y� >��SSSttt`KSttti`titStiSStS : z S G' : i ? ?S 9 Y P �, l, 1 , t 4m9 a p2. p f Cc !._ Bondi Bonding OF F 1. c -r'icx 1-00.3.1-131703 Vat AcAA laaaaalaaaialaaaaaaaa RADON C.C.F. APPROVED: Zoning Mechanical Building Plumbing 3V Tax Folio . Master Permit # Estimated Cost (value) 4 110 Signa n e of Contractor or 'i wner- Builder y to Contrac ommission Ex > p \.... Y P_, ` L '1 I. F;'.d @r = �k�,' rT , iT. f2.a'ofr ?ori :°? + i. Cr 4 ?ila07 oFR•U ,,l i ..: .......: .....:.i cJC7 /15/99 ) 1- 800.3- ?73TARY • rii h'r y . r i & Bonding Co. ' NOTAR ef!!!!!!!!i!lli.E!llrffl A < DUE 3 Electrical Engineering er- Builder Date 3-01-44 Date Scale: Each block represents 5 feet and 1 inch = 50 feet. ■ •.■■ •••■ u •••••• OR • ••••••••• ■ ■A ■.••..■. • ■ •• • ■ ■• • .•.■ • ■.■ NMI IN NUM ■ ■ ■.•■... ■•••••••t...■ MUM •■r -- - u..Ei•ii: MI �u.•s : ::::_u•••u ... •iiur .) ■ ui . i, 11 •i ••I. :: nom. _ ■ ■ ■ ■ ■ . • _ • ■.■ ■ ■ ■i•■ ■■. ■ ■• ••••••• INNUI • UMW •■■ .I C...C.I •••••••• u :C ■ •••u 1110•11111111 ■• ■1�■ =Nam m ■ ■ ■■1 • •UUI • NNN .I. ::o ■■ : ••CC •m■ 91 !1 1• 1 C ■ ■ 1 ,110111 ■ : •• ■ ■ii M I : ail: c t.• • 1 MM ■ ' IN l • :: ■ .■ • ■U - ■ ■ ■•• ■ • •uu ■ ■I •I CC II■■ ]— •_■ 1 C ■ . :C1 ■ • C ■ ■• - -� • ■ 1. ■.C ■ . .D • • I _ � - - - I • ■;) I MO . • • MINN. •.■ _ 1 _ II , • IIU •:C: ' E ,1 - -■ U • al Ell _ -( f _ - ■■ • - - - 1 -1 t - - I • FI _ - 1 a I T f 1 • ■ - ■ ■ I- -J _1- 4--ri -1 i - I _ I - _ -- _ 1-3_1_1_ _ ; _ • _ I I - 1 - - - - - - .. =- _ I 1 1 � � _ _ - 1 _i_ • I _ �I_ ' _►_ 1 i J . _ • ■ III I ���_ _ 1 __ ■■ U� • il■ ■ ■ ■■ ■ ■ _ - I _ _ -- ■ U _ - -- I 1 � I 1 • n�i 11 1 J ■ I ■ • . /■■ ■. ■■ ■ ■ ■I ■. ■■ ■••. ■■■ ■.. ■ I it II 1 1 1 i I � 1- �-. r • . • .. C■ . ■ .•••■• . 1 ■ ■ ■.. . .. .• . ■ • U. • mum. � ■ 1u 1 • ■ .• .. •C sm.... ....... ■C ■■ Si I . ■ rt fit' -- - - -- Notes: WILLIAMS: 504 NE 101 STREET 33138 mc 1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIQN PERMIT (� Permit Application Number 1 6e- t / 3 Site Plan submitte d by j Plan Approved OLD SYSTF1 OVERFLOWING. WATER CONSUI1PTION: not available PART II - SITE PLAN SI NATURE ,N of Approved SEPTTC "[WPM)! /Gr f 676 By ALL CHANGES MUST BE PPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes pr u s editions which may not be used) (Stock Number. 5744-002-4015-6) TITLE Date f /5G. County Public Unit Page 2 of 3 CONSTRUCTION PERMIT FOR: [ N ] New System [ Y ] Repair APPLICANT: WILLIAMNS PROPERTY STREET ADDRESS: LOT:S i c k • l PROPERTY ID #: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: 'Chapter 381, FS & Chapter 10D -6, FAC [ ] Existing System [ ] Abandonment BLOCK: ifs SUBDIVISION: //..32 0 e3 17 x SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPECIFICATIONS D R A I N F I E L D 0 T H E R DATE [ N ] [N ] 504 NE 101 STREET, MIAMI SHORES, FL EXISTING T [900 ] [GALLONS / tail] SEPTIC TANK /AEROBIC *NIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ J A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ J GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] W [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] [ 400 ] SQUARE FEET laM5y DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [X ] STANDARD [ ] FILLED [X ] BED CONFIGURATION: LOCATION OF BENCHMARK: [ J TRENCH r?r?E 7.31! mall ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE [ AGENT: NORTH DADE SEPTIC TANK I 3 4 ,.. ,; xO/td S Ss r . 4- 4 NUMBER] [OR TAX ID NUMBER] FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ INSTALL 12" OF LOAMY COARSE SAND UNDER BOTTOM OF DRAINFIELD SUBMIT BENCHMARK BEFORE INSPECTION. SPECIFICATIONS BY: APPROVED BY: THIS PERMIT IS Nur MK ADDITIONS. INVExT ELEVAllull (raNiriur]): .5 Hs L 1 ? uTTOM OF DRAIA IELD ELEVATION (MINIM1M7: 4/, 3 N z L— HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001-4016 9ak_ 06 9 PERMIT # DATE PAID 4Cl rA6, FEE PAID $ 5o.0 RECEIPT # INSTALLER /CONTRACTOR Temporary /Experimental Holding Tank [N ] Other(Specify) [ ] MOUND [ ] [ ] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE ] INCHES TITLE: TITLE: ,- CPHU ISSUED: THE S f C TANK HALL BE PUMPED AND A SOLID EXPIRATION DATE: N DEVICE INSTALLED ON THE OUTLET TEE, POINT POINT , Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. APPLICATION FOR: Check type of permit, if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID(i: 27 character id number for property. (CPHU may require property appraiser ID 1) or section/township/range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 1OD-6, FAC. DRAINFIELD:•• Minimum specifications from Chapter 10D-6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Nance of individual providing specifications. if designed by a registered engineer must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. i~XPLZATION year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. �•x, 3a'j l ermj.. No.... ..__..... - - __ -- Jwner's Name and Address. - .egist :red Architect and /or Engineer ?mploying Plumber's Name . Rose Septic Tank CO 1 37' 33011 Location and Legal Description Lot. Street and Number where work is to be performed —No 504 State work to be performed and purpose of building (By Floors) New Building Remodeling k__. Size Septic Tan Feet of Drain Tile .._._ -_ Nature of Water Supply: City —Well Amount of Permit $ 6.00 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date..._ 11 -4 -80 ,iippliciitnin is hereby made for the approval of the detailed statement of the plans and specifications herewith subw,.,1 for the building or other structure herein described, This application is made in compliance and conformity with the Building Ordinance of Ml •t Shores Village, Florida, an all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic' of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications must be kept at wilding during progress of work. No. — ._ ___ _. —.__ _ __ Street, . . 885-9i g5 - - .-..�. a....... stregt........ Block Subdlvision..,,..._..- N.E. 101 street stme Addition - -- ._. ..Type of Tank - Capacity ^ .als. _ __Dist. Feet of Tank or Drain Field from Well ......--- ....----- • - -•.- (Signed)-C --- hklLL (Signed). Repairs Say No of Stones --Size of Soakage Pit My Commission Expires Notary Public, State of Florida PluFnbin:; Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n;Iloyer of !oho under the Florida Worinnen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent rum lement, and hu% e�h i• '.lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in ' o . AO rk v b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pnhl; notice al no leer .41 a,? requ+red by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed this �:rl.tit al • licensed by Miami Shores Village. Mast,a Plumber. STATE OF FLORIDA, is. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per;orrt ; , ppeareti 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 tnat all acts therein by him stated are true. NOTE: A re- inspection fee of I$1.00 will be made when awl re- inspection is made•neceoary by improper notice for inspeet'on, tr fruity materials and /or workmanship. CLOSET• BATH Tu•e SHOWER• LAVA• TORIES 61NK• SLOP SINKS LAUNDRY Tugs URINALS CATCH DAMN FLOOR DRINKING DRAIN FOUN I — ter TOT..L PIETA R[• -- - CONTR. LI "T _— - _ T _ - CHECK SEPTIC TANK SEWER CONK. DRAIN F IELD SOAKAGE PIT G TRAP SOLAR H DEEP WELL BPRKLR. SYSTEM SWIM'O POOL —T i CONTR. LIST 3 2 t i .. _� - L..�– — - CHECK �•x, 3a'j l ermj.. No.... ..__..... - - __ -- Jwner's Name and Address. - .egist :red Architect and /or Engineer ?mploying Plumber's Name . Rose Septic Tank CO 1 37' 33011 Location and Legal Description Lot. Street and Number where work is to be performed —No 504 State work to be performed and purpose of building (By Floors) New Building Remodeling k__. Size Septic Tan Feet of Drain Tile .._._ -_ Nature of Water Supply: City —Well Amount of Permit $ 6.00 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date..._ 11 -4 -80 ,iippliciitnin is hereby made for the approval of the detailed statement of the plans and specifications herewith subw,.,1 for the building or other structure herein described, This application is made in compliance and conformity with the Building Ordinance of Ml •t Shores Village, Florida, an all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic' of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications must be kept at wilding during progress of work. No. — ._ ___ _. —.__ _ __ Street, . . 885-9i g5 - - .-..�. a....... stregt........ Block Subdlvision..,,..._..- N.E. 101 street stme Addition - -- ._. ..Type of Tank - Capacity ^ .als. _ __Dist. Feet of Tank or Drain Field from Well ......--- ....----- • - -•.- (Signed)-C --- hklLL (Signed). Repairs Say No of Stones --Size of Soakage Pit My Commission Expires Notary Public, State of Florida PluFnbin:; Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an a n;Iloyer of !oho under the Florida Worinnen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent rum lement, and hu% e�h i• '.lied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in ' o . AO rk v b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pnhl; notice al no leer .41 a,? requ+red by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed this �:rl.tit al • licensed by Miami Shores Village. Mast,a Plumber. STATE OF FLORIDA, is. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per;orrt ; , ppeareti 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 tnat all acts therein by him stated are true. NOTE: A re- inspection fee of I$1.00 will be made when awl re- inspection is made•neceoary by improper notice for inspeet'on, tr fruity materials and /or workmanship. MIAMI SHORES VILLAGE. FLORIDA BUILDING ❑ ELECTRICAL ❑ P E R M I T N• o PLUMBING ® 8268 ROOFING ❑ Work to be performed under this Permit lrt t•i t A.., c k �. Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot NS jl c Jo» .» _P CONTRACTOR OR BUILDER r 4.0 C t'! Bl. Signed• J Subdi- vision Sq. Ft Value of Project $ 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 thor,owletknowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or the sta tments or specifi" (ions and that he assumes responsibility for work done by his agents, servants or employees. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered,/hereunder in compliance with all ordinances an ations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications ,,saubmitted to the proper authorities of Miami Shores i . In accepting this permit I assume responsibility for all work done by either, myself, my agent, fiervant or employee. BY DATE 1- L Contractor's .3 1 a 1 License No ti tC . / r f't • Amt. of Permit $ AUTHORITY J ._. Permit No Date Application is hereby made for the approval of the detailed statement of the plans and specifications here ' li 6bmitted 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 a building during progress of work. Owner's Name and Address_ 1�� _ ___ _,. .__ _ _ _ -.._- :___ No. __.___ 014 Street- 1__!._ /Z. _.J O / Registered Architect and /or ngineer _____ __ -. _ _ 1 Employing Plumber's N _ -t -- •S� ' - _�� -- - 1c Street____2/ -- -'._ l .... — Location and Legal Description Lot_____________ _ ____ ._____ Block _ __________. Sub visio __ ...... _ _ .__ _ �� _ 6__. I01 Size Septic Tank Feet of Drain Tile_ Amount of Permit $ Street and Number where work is to be performed —No Nature of Water Supply: City — Well..- / MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING Street � State work to be performed and purpose of building (By Floors) ___. _ New Building __ ___ Remodeling__—__ ______ Addition- _-_--_._--_-_ ...... Repairs No. of Stories Type of Tank Capacity Gals _Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o• gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Peri anent Supplement, and bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors -Inployed 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 ork to be performed under this permit, as are licensed by Miami Shores Village. ♦ , i (Signed)... Master Plumber. STATE OF FLORIDA, } u. 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES INKB SINKS SLOP SINK LAUNDRY Tues URINALS CATCH BASIN FLOOR DRAIN DRINKING DRINK FOUNT' NS TOTAL FI %TURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW I POOL CONTR. LI.T - - CHECK ._. Permit No Date Application is hereby made for the approval of the detailed statement of the plans and specifications here ' li 6bmitted 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 a building during progress of work. Owner's Name and Address_ 1�� _ ___ _,. .__ _ _ _ -.._- :___ No. __.___ 014 Street- 1__!._ /Z. _.J O / Registered Architect and /or ngineer _____ __ -. _ _ 1 Employing Plumber's N _ -t -- •S� ' - _�� -- - 1c Street____2/ -- -'._ l .... — Location and Legal Description Lot_____________ _ ____ ._____ Block _ __________. Sub visio __ ...... _ _ .__ _ �� _ 6__. I01 Size Septic Tank Feet of Drain Tile_ Amount of Permit $ Street and Number where work is to be performed —No Nature of Water Supply: City — Well..- / MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING Street � State work to be performed and purpose of building (By Floors) ___. _ New Building __ ___ Remodeling__—__ ______ Addition- _-_--_._--_-_ ...... Repairs No. of Stories Type of Tank Capacity Gals _Dist. Feet of Tank or Drain Field from Well _Size of Soakage Pit (Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o• gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Peri anent Supplement, and bus com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors -Inployed 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 ork to be performed under this permit, as are licensed by Miami Shores Village. ♦ , i (Signed)... Master Plumber. STATE OF FLORIDA, } u. 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, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship.