636 NE 101 St (14)Architect/Engineer
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date F// 7 /1? Job Address 6.?‘ Aw 7. Tax Folio 32 0 /7* 2/24
Legal Description ZIP 6 7 ( 7 $15 /S4 Historically Designated: Yes No
/ t: &�
Owner/Lessee / Tenant H • if5, N/er / 5s0/V Master Permit # 3 f g
Owner's Address 6% Ate mi ST, /`t . f`exeS, X 33/0 Phone 34 1/"1". e7
C o n t r a c t i n g 1 /2 ham 7 JP� 1 Address 180 J2() /l8 64 •
Qualifier /2 '�'11n. .Lr' 7 SS# 95; . . Q/3t
State # eirezaal Municipal #
Ault/ Exam:-AX AA-.
Competency # Ins. Co.
Address 78 7#
^ e4t4t / •/
Bonding Company 'r ,/l Address
Mortgagor Address
Permit Type (circle o , e): BUILDING LECTTRICAL UMBING ECHANICAL ROOFING PAVING FENCE SIGN "
WORK DESCRIPTION
40
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 will be done in compliance with all applicable
laws regulating construc ' . and zoning. Furthermore, I authorize the abov- . ed contract r to e work stited.
of owner and/or Condo President Date
/ o
7 /c9 7 /Q?
Notary �as -to Owner and/or Condo President Date
My Commission Expires:
, ,-& ' O
FEES: PERMIT 6
h Y P OFFICIAL NOTARY SEAL
U yP Z U 6 < � DOLORES Y IMBERT
n COMMISSION NUMBER
Gtl n III a
` CC751125
4- MY COMMSSION EXPIRES
OF F O,O JUNE 14,2002
RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Estimated Cost (value)
- Builder Date
/ 5/6 „/, ( 3
Notary as to`Contractgr or • ! ,.1:,.; ;t+
My Commission Expit'g ARypum i : .;.7r;�t" cx -1,1!--,"7,:.::.; 5 _,
Engineering
C.C.F. ° 60 NOTARY 5 BOND :36o
TOTAL DUE
Electrical .2 -ce
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 97 7/49 Job Address 636 X#E 1IN S' 7• Tax Folio / 72 "• 6 g r 61 / W240
Legal Description 107 6 7 7/4.4/"6*Q ' »" Historically Designated: Yes No
� ,� ' r t
Owner/Lessee / Tenant Mti • 7 ,.I • v'� s ikoisreal Master Permit #
Owner's Address ‘S ° AV /d /.f7 ,4 w £4M6 )T 3i/0 Phone 34 • 7//". Da6 7
//����,,,,��� X80 /4)/4 k / � M!.4t
Contracting Co.� �/`� ` . Addres
ss# Phone 1V1. P144 a /3T
State # C /7L/ Municipal # Competency # Ins. Co.
Qualifier Anrit NA /
Architect/Engineer 4 P &
Banding Company ArA Address
Mortgagor Ark Address
Permit Type (circle one): BUILDING ELECTRICA PLUMBING
WORK DESCRIPTION � � /P«.
Square Ft.
—P C-L
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEME 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 .,work will be done in compliance with all applicable
laws regulating constr / uct' • - : d zoning. Furthermore, I authorize the abov amed con .. •• the workmtated.
i
-Si
f owner and/or Condo President
My Commission Expires:
FEES: PERMIT RADON
Date
74, 7/99
Notary o Owner and/or Condo President Date
OFFICIAL NOTARY SEAL
1PRY'o DOLORES Y IMBERT
2 -1L r n co meas510N NUMBER
N it a CC751125
y > � , ' o MY j O� OSSION EXPIRES
OF
C.C.F.
Address
MECHANICAL ROOFING PAVING FENCE SIGN
Estimated Cost (value)
70014444 ep4*ei c, #44"44
GP
er- Builder Date ' ig."7.
q � b"d,PvLha JI lv, ! '
No : as to Con actror,Own ' : � •, - Date
�aa1"`t1 1"/piit�F�T� TI
My Commmssion Expires: =CPI-
. 7ltl
NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
a
' iv`+.' k ""tv+'F�!""R�dt""d4�3r�wta..r+► - —..�!
RECEIPT
flECL IvLU H iUM
ADDRESS 634
FOR
DATE / S / � NO. 0 310
e 5
DOLLARS $ 7S'
AC( UUN
CASH
zUtt iitfi8
MUNEY 0110EI1
'vru1
AM I. OF
ACCUUNr
AMT. PAID
DALANCf [1111'
1b4 UA
HOW PAID
t
a •
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO. 06 • O /7' 2 /70
STATE OF FLORIDA:
COUNTY OF DADE:
998393532 1999 JUL 29 10 :24
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: 107 !o 1 7 /iii c/ 46X r ,pt) „/V. P/
p — /�.' ,cK /c,e,
( 636 ,r s /o/ Jar., L #1$4i I -3T/34
fit j AiNtLc fiereo 4fia .
2. Description of improvement:
3. Owner(s) name and address:
436 # /D, �'t• A4Jmt44 Alisteet, 733/3/
Interest in property: $/.IM t IE `G ace -ic)
Name and address of fee simple titleh
4. Contractor's name and address: �y � � 004- - . •
49 f2) /4
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address: A/
Amount of bond $
6. Lender's name and address: 4 � ”
7. Persons within the State of Florida designated by Owner upon whom rti
by Section 713.13(1)(a)7., Florida Statutes,
Name and n- /� /
address: % ' /'fit /C On Z C . � �i, d Z/fi
f uJ ! _ 3
f$d / g � /G '-' " 3 3�-
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
• Name and address:
„9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified) /
Signature of • er
Print Owners Name � AC 0,U J (1 r `/ (ri6
Sworn to and subscribed before me this a day of .. LL Q , , , 19 9 .
Notary Public (I
Print Notary's Name
My Commission Expires:
/Lei, "Ar4
i
NOTICE OF COMMENCEMENT
/141. fAt�d �/�4te dw6�' Apt) sso
ACIAL NOTARY SEAL
,1PpY P ' 1 6 DOLORES Y IMBERT
1 n ooYNISSlOM NUMU
1 l
CC751125
0 COMMISSION EXPIRES
E 14,2002
OF Fk
-/ C.J7A-74 f 4 d f / 7331
f arty !i. ,': . ^. Y.... c,,
ar of ocuments may be served as provided
Prepared by: a - • ` q
Address: Tva J /(8 AG.
12301.52 2193
SWIMMING POOL OWNER'S CERTIFICATION
Date 7 / 74 / 9 y
Miami -Dade County
Department of Planning,
Development and Regulation
Attention Building Official: •
I certify that I a the Iegal owner of the pr pe y described as X07
fa
/1";/‘? , located at 6360 / ■SDI S7. .i /.7t ?v
In accordance with Section 33 -I2(e) and (f), Code of Metropolitan Dade County, I
certify that I understand and agree that the swimming pool to be constructed at the above
address cannot be used or filled with water until a separate permit has been obtained for an
approved SAFETY BARRIER, INCLUDING A SPRLNG-LOCK SELF - CLOSING
GATE, (double gates must be constructed to the standard described in memorandum
dated October 12, 1994 in order to meet this requirement), equipped with A SAFE
LOCK (no padlocks are permitted on pedestrian gates; padlocks are required on non -
pedestrian gate leaves of double gates) and utilized when the pool is not in use and such
barrier erected, inspected and approved.
I further understand that this certification, however, does not eliminate the need for
obtaining a permit and erecting an approved barrier prior to final inspection and use of the
pool.
I have read and understand the reverse side of this form.
NOTE: IF AT THE TIME OF FINAL, THE ABOVE REQUIREMENT HAS NOT BEEN
MET, THE OWNER WILL BE CITED WITH A ZONING VIOLATION
Ste 33 -12 fences and safety barriers for swimming pools
Required for feral inspection of pool. No final inspection and approval fora swimming pool
shall be given by thc Building and Zoning Department. unless there has been erected a safety barrier as
hereinafter prodded. No pool shall be filled with water unless a final inspection has been made and
approved c.cept for testing purposes as may be approved by the Building and Zoning Department.
(b) Types permitted Thc safety barrier shall take the form of a screened -in patio. a wooden fence. a
t+ire fence, a rock wall. a concrete block wall or other Materials. so as to enable the owner to blend the
same with the style of architecture planned or in existence on the propery.
(c) Height. The minimum height of the safety barrier shall be not less than four feet (4%.0").
(d) Location of Barrier. The safety barrier shall be erected either around the swimming pool or
around the premises or a portion thereof on which the swimming pool is erected. In tither event, it shall
enclose the area entirely. prohibiting unrestrained admittance to the enclosed area. Pools located in
enclosed structures or on the roofs of buildings shall not require the installation of barriers as required
herein.
(e) Gates. Gates shall be of the spring lock type. so that they shall automatically be in a closed and
fastened position at all times. Gates shall also be equipped with a safe lock and shall be locked when the
swimming pool is not in use.
(f) Permits. Before any work is commenced perm shall be secured for all swimming pools and
for the safety barriers. Plans shall contain all details necessary to show compliance with thc terms and
conditions of this chapter. No swimming pool permits shall be issued unless simultaneously therewith a
permit is secured for the erection of the required safety barrier. provided however. that in lieu of the
permit for a safety barrier, a written statement from the owner certifying that he understands and agrees
that the pool cannot be used or filled with water until a permit has been obtained for such barrier erected
inspected and approved will be acceptable. This certification. however. will not eliminate the need for
obtaining a permit and erecting an approved barrier prior to final inspection and use of the pool. If the
premises are already enclosed as hercinbefore provided. permit for the safety• barrier shall not bc required
if. upon inspection of the premises. the existing barrier and gates are proven to be satisfactory.
(g) Wooden fences. In the wooden type fence. thc boards. pickets. louvers. or other such member:.
shall bc spaced, constructed and erected. so as to make the fence non - climbable and impenetrable.
(h) Walls. Walls. whether of the rock or block type. shall be so erected to make them noon-
climbable.
(i) Rite fences Wirc fences shall be the two inch chain link or diamond we non - climbable type.
or of an approved equal. with top rail. they shall be of a heat). galvanized material
111 Refusals of permit k shall be within the discretion of the Director to refuse approval of a barrier
hich. in his opinion, does not furnish the safety requirements of this section. i.e.. that is high enough and
so constructed to keep the children of pre- school age from getting over or through it
(k) Maintenance. It shall be the responsibility of the ow and'or occupant of the premises upon
which the swimming pool is hereafter erected to maintain and keep in proper and safe condition the safety
barrier required and erected in accordance with this chapter.
(Ord. No. 57 - 19 $ 5. (CC), 10 22 - 57; Ord. No. 64 -53, § 1. 10-23-64; Ord. No. 74 -33. ¢ . > -7 -74)
Date Job Address 636 Air //7Z7 Tax Folio /4 • 06 " 0/7 2/20
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Master Permit # - 5 3 loll asp 4 '/
friiP. mid .1ArC4665 b ojSsa l
Contractin Co. Ea S9 On E1e Z" I c
per BerNarao A Chcale ss#
State # q 3 - E0004 8°I Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION POO t
Square Ft. Estimated Cost (value)
A d d r e s s & D 2 (A) . (g Lai
Phone 305 -7 .2- oa Ser3d-
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 -rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construc and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
ignature of owner and/or Condo President Date
OFFICIAL NOTARY SEAL
O 1P I Y pi,'
U dei DOLORES Y IMBERT
2 �1 n COMPASSION NUMBER
7' �P MY OMMSSI9N EXPIRES
OF f .° JUN 13,2Uue
c CC751125
Notary as to
My Commissi
APPROVED:
Zoning
Mechanical
er and/or Condo Pres i �iif Date
FEES: PERMIT I/3`7 Oa RADON
Signature of Contrac .r
Not ' as to Contractor or Owner - Builder
My Commission Expires:
N u.11, UVIA SANGHEZ
*: ' MY COMMISSION /CC 546215
EXPIRES: April 8, 2000
3m 0 � Banded Thu Ndry Public Underwrites
m
Phone
ft -
C.C.F. NOTARY
Building Electrical
t 500 00
81271
Date
Date
BOND
TOTAL DUE �7 ✓ �
Plumbing Engineering
Miami Shores Village, Fla.
OWNER
ADDRESS
INSPECTION
TIME READY
TELEPHONE NO.
PERMIT NO. 4(x3/7
CONTRACTOR / O'i
6 3; A/ /i /0/
901— vai-y — /3 V
DATE
Owner's Name and Address
Registered Architect and /or Engineer
Name and address of licensed contractor
(Signed)
STATE OF FLORIDA,
COUNTY OF DADE. j ss.
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
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.
• Location and legal description of lot to be built on:
Lot T — r ' ' - ‘ 7 Block -/ a Subdivision
Street and Number where work is to be done
State work to be done and purpose of building (by floors)__
fie
New Building ___ y . modeling Addition Repairs No. o
To be constructed of � Kind of foundation �" 4: z `., re r y, Roof Covering
,� "C r
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required _Plan Cubage_
4 .—
Distance to next nearest building 4 ,4 Si ze of Building Lot
Maximum live load to be borne by each floor
a»-
____________________________ and for no other purpose.
CE
• -
I hereby submit all a plans and specificatioirs,for said building. All nptiees with reference to the building and its construction may
t r .: r j i j�
be sent to -- - - `� !
-t �
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) 1 j /•` /t J t'
_i / - / t ;" ' 7- l
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared --
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.
� '
/1' 1 .t
Permit No `• Date ' / ;____ Read, Sworn to and Subscribed before me.
Disapproved Date
Notary Public, State of Florida
Building Inspector , My Commission Expires
4 i� ,PLANNING BOARD � r , , ` DATE
Chairman (� _ sa.' -- `_ -!_ -- -- —� t -� _ _- -•— ,,�Member
Member _ ; y ' r u� - -K."' Member
Member _ __ _ _____ _ __1/ - '"F_ 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 by improper notice for inspection or faulty
materials and /or workmanship.
:r ! •
to me well known,
Permit No 11
Registered Architect and /or Engineer
Employing Electrician's Name
STATE OF FLORIDA,
COUNTY OF DADE. ss.
r ,,ll
MIAMI SHORES VILLAGE
ELECTRICAL FNSPECTION DEPARTMENT
APPLICATION 0 ELECTRICAL PERMIT .ji • V6=
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.
f
A_. / . / /
Owner's Name and Address ,z_ _ '' 4 ' !m_ `__ ` ` �_ No.____ _S:'____ Street .1
r �:_ - :
State work to be performed and purpose of building (By Floors) . ' Y
No Street
Location and Legal Description _ _____.
•
Street and Number where work is to be performed —No .�.r
(Signed)
New Building.. t Remodeling Addition.___________________ —_ Repairs
Date
Street
No. of Stories ____
Service Overhead Size Feeders Conduit._ Main Sw. �___ — Amps. Main Fuses Amps.
Underground
Type of Installation — Conduit t' Tubing ' __ —_ B.X.L. Metal Moulding
Amount of Permit $ / 0 (Signed) 137 ' /
Electrical Ins or
1 f The undersigned applicant for this building permit does hereby certify that be understands and accepts his obligations as an employer of labor
I 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, on work to be performed under this permit, as are
licensed by Miami Shores Village.
/ ! i f
Master Electrican.
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 be 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
I
i ` ..
�f
, !
/ tea.
/
/
/
In 0
CHECK
ENT.
SW.
DIST.
CAB.
SERVICE
TEMP.
SERVICE
PERM.
MOTORS
O -I HP
MOTORS
1 -5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
�f
v
/
CHECK
Permit No 11
Registered Architect and /or Engineer
Employing Electrician's Name
STATE OF FLORIDA,
COUNTY OF DADE. ss.
r ,,ll
MIAMI SHORES VILLAGE
ELECTRICAL FNSPECTION DEPARTMENT
APPLICATION 0 ELECTRICAL PERMIT .ji • V6=
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.
f
A_. / . / /
Owner's Name and Address ,z_ _ '' 4 ' !m_ `__ ` ` �_ No.____ _S:'____ Street .1
r �:_ - :
State work to be performed and purpose of building (By Floors) . ' Y
No Street
Location and Legal Description _ _____.
•
Street and Number where work is to be performed —No .�.r
(Signed)
New Building.. t Remodeling Addition.___________________ —_ Repairs
Date
Street
No. of Stories ____
Service Overhead Size Feeders Conduit._ Main Sw. �___ — Amps. Main Fuses Amps.
Underground
Type of Installation — Conduit t' Tubing ' __ —_ B.X.L. Metal Moulding
Amount of Permit $ / 0 (Signed) 137 ' /
Electrical Ins or
1 f The undersigned applicant for this building permit does hereby certify that be understands and accepts his obligations as an employer of labor
I 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, on work to be performed under this permit, as are
licensed by Miami Shores Village.
/ ! i f
Master Electrican.
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 be 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.