101 NE 102 St (3)I _ _ 10050 N.E.2nd Avenue
�,y�,� ores, Florida 33138
L _.__" T it es" 7 an(3 5) 756.8972 p 5
I 6C ZOO,
BUILDING t E r, " 21103 Permit No.
PERMIT APPLICATION_
FBC 2001
Permit Type (circle): Building Electrical /
Owner's Name (Fee Simple Titleholder) // e a L' id • ` / Phone # 3 0 7' 7.3 ,/ 0
Owner's Address / 0 / /7 .(,,[l 1 0 '7 (R-9
City m /Q to) 5.h 04.6 State Fin
. Tenant/Lessee Name Phone #
Job Address (where the work is being done) / A/ j &/ /b2 41
City Miami Shores Village County Miami -Dade Zip � ei /SD
Is Building Historically Designated YES NO
Contractor's Company Name i' 2 X et eL // e4z
Contractor's Addre 4 A/ 6 ?Zvi'
City �� j /.0 State .1` Zip 33/ ..74e
Qualifier ./.7"C7,4 L?` -/3 -e-P
$ Value of Work For this Permit 0 '
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
Building Department
Plumbing
Master Permit No.
Zip 3 7 / S�
Phone # 2S 9 s /
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
Type of Work: ❑A 'lion ❑Alteration , ❑New ❑ Repair/Replace ❑ Demolition
Describe Wor
e--e/
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ 5() ('k I9i2 Permit Fee $ / 424P ° v CCF $ ) ti D
Notary $ r, .C Training/Education Fee $ . Technology Fee $ ,S c
Scanning $ Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Mechanical Roofing
Bonding Company's Name (if applicable) 1
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDMONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure , ' I be delivered to the person
nt must be post - ' tie job site
absence of suc posted notice, the
whose property is subject to attachment. Also, a certified copy of the recorded notice of comme
for the first inspection which occurs seven (7) days after the building permit is issued.
inspection will not be approved and a reinspection fee will be charged.
Signature /1'', . J7/ / /
Owner or Ageiw
Sign:
Printfl Q Q
My Commission Expires:
State Certificate or Registration No.
Chc 10/14/03
c
The foregoing instrument was acknowledged before me this
day of \ \-•C �. , 29 -, by ,i
who is personally known to me or who has produced
As ide{�4ificatiop who did take an oath.
NOT LY PU IAC: =, m!11 Ss l Vargas
mmission ODD23I984
re • Ju 13
Bonding Co., Inc.
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
Contractor
The foregoing instrument was acknowledged before me this2''f
day of KID) , 2003 by I-' 11-.1s000 3 ,
who is personally known to me or who has produced
it 'i I55325 . O as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Certificate of Competency Holder)
Certificate of Competency No.
* * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * **
Plans Examiner
Engineer
Zoning
M
H TUB
UNIT
FEE
ITEM .
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE •
ET
LIGHT OUTLETS
CENTRAL HEATING
,WASHER
RECEPTACLES
A/C (WIND)
?OSAL
SERVICE TEMPORARY
A/C (CENTRAL)
NKING FOUNTAIN
SERVICE SIZE IN .WS J
DUCT WORK
DRAIN
SERVICE REPAIR/MIETER CHAFE
/
REFRIGERATION
.R
.ASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
"ERCEPTOR
RANGE TOP
UNDERGROUND TANKS
'ATCRY
OVEN
ABOVE GROUND TANKS
INDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
ITHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
IWER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
iX, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
•X. RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
X, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
PCRARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS.
INAL
MOTORS OVER 25-100 HP
COOLING TOWERS
TER CLOSET
MOTORS OVER 100 HP
VIOLATION
OIRECT WASTES
A/C WINDOW
REINSPECTION
TER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFCRMERS
HEATER- REPLACE
GENERATORS TRANSFCRMERS
LAWN SPRINKLER WILL
SPECIAL PURPOSE
•
SW I)J I NG POOL
CUTLETS COM ERC I AL
WATER SERVICE
SIGN TUBES
WER CONNECTIONS
SIGN TRANSFORMERS
ILITY -SEWER
SIGN TIME CLOCK
ILITY -WATER
FIXTLRES
?TIC TANK
ANTENNA
LAY
TELEVISION OUTLETS
AINFIELD, 4' TILE/RES.
VIOLATION
MP & ABANDON SEPTIC TANK
REINSPECTION
AKAGE PIT CU. FT.
TCH BASIN
SCHARGE WELL
'MESTIC WELL
EA DRAIN '
=
:OF INLET
��
:LAR WATER HEATER `
RE STANDPIPE
==
CI. PIPING
CNN SPRINKLE SYSTEM
-
LS
:TER SET (GAS)
.S PIPING
-_
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
4 APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
3TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
ELECTRICAL
MECHANICAL
1
•
RV10E
Ybi At S led-1
.1 •
:• ALL ;CoN'Du ; S►ZED T
T14RU ROOF H f~1GHT Ascri G.
ROOF - Mt:• 2'0" .MA' .38''
MltNt! RISER 2 ". RIC -t,D/ IMC
i fr
I , y t &7
! 1 , 1
v� t C. ` o !7/Ibi :
1 .Ito
... , , �.: 1 RAT t• �4 i ..�,
I
'' '_. ! : I
. 1.
1 - • i '• ,' . ! - '• 1 . ' :. .. 1 ; :
�.... ; .. �__ 1 . •
MAI.N...-;._2.30.;_PA Rt.
F. :..
I o FV.sE 1..�); �3RE KG.R
. .. f C l �. I �ST� ' 1 .. ,
i
...I. 1... . . i. •
. P.ANE.L F.EEUF R. otd
i CQN`VRACTOR ii/.Z 1 Pk01\1L. dQS 7 7- /8
1 I I
AMPS
1 ;
1-
_ ; GOUDu tT � /Y'G' 8 •
. ' . Ground w . p er ^ 20 9 5
1 1
I
GA►2RY; LRD, O 'CAL / ,rt`t�, PER 220.
o CLGA�?At�1Gc.S i'L 30, -2 4 4,8.0
i o PR L oP I S I. 230: 0 54; t-i)
THR � o T+lE RooF . 3C •
i •SF;56 ; 4.50. i (f)`, NE:C 230 -28
4 S FBG 34.9 7' °1 ( FORS ROOF
• ?f�NE.
F :SCAL�
TNR1! po ca) `(�.5 Q., N1,0 '
1. ; 1 1 1 .
1 1 ! i
! 1 1 ` , 1
H Gr T o . ccNr�.F? o t- METkR
(PL)! 5; 40 ;6
c
..l 1 I • ' .
OUTSID.a 1 . - D.i. couNecr.. !._.. _
!._.'
SF13;C.' .504, :, I CA- )..!... :;.
M'cun ,E
1 : 1 c) Pus 17 5 b) i k8're .�ccr
1 c) 5-r :P»J4 . L. . .
Gi? E CC,: - -,
40.1.11?. ! . ? 5 0 9 4 ;
•
1
Cw.P ; ; 1 ; : • 1 •
1 . ■ 1 1
I GROUND tNG • F1.ECTRa!0P.
S :.'. - C.NIRLY_.._ITH . 250:.1.1 2 11 :.W il. ., APP•t -I CA51 -e. - ' _
;.: .• ; E • ; .. � , " � 1. o_ � ' ND. w .3J5t-lI N CZ6.. `2.5c� -"1Z I Cc.i) 1 : . . : .... :...
• :.. I. ! .. ' !33 :FPL: ) QutRt= S, Mt~ t_.R; 5'' - -�0`! AP.A• ..GRr .,
I ..:. 1 I_. ' ! (...To: GCNTtr R O..ME`i'ER -) :....: '
• . : : •
1 A PPROVED.:
•
. :. . . . . • l C .`RJC:AL.. D.IV.(S.i4N.:.
•
1
MI ELECTRICAL INC
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: EL2003 -352
Printed: 12 /2/2003
Applicant: H
Owner: MORGAN
JOB ADDRESS: 101 NW 102
Contractor M I ELECTRICAL INC
Local Phone: 786- 295 -9521
Parcel # 1131010220050
Signed:
Electrical Permit
MORGAN
H
ST
Contractor's Address: 411 NE 87 ST
Page 1 of 1
Legal Description: GOLD CREST A SUB PB 21 -56 LOT 13 AND BLK 1 E1/2 OF LOT 14 LOT
Fees: Description Amount
FEE2003 -7635 Building Fee $100.00
FEE2003 -7636 CCF $1.20
FEE2003 -7637 Notary Fee $5.00
FEE2003 -7638 Training and Education Fee $0.40
FEE2003 -7639 Technology Fee $2.50
Total Fees: $109.10
Total Fees :$1. ,Q
Total Receipts: 0.00
51 1-0
Permit Status: APPROVED Permit Expiration: 5/29/2004 Construction Value: $1,200.00
Work: RELOCATE EXISITNG OVERHEAD SERVICE INSTALL NEW 200 AMP METER COMBO INSTALL NEW GROUNDING ROD
(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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Die MIAMI SHORES VILLAGE
Permit No
Owner's Name and Address
Amount of Permit $
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date ' ° )
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.
6urv1
(Signed)
(Signed)
No I `a r
Street .... /.: Jr,
Registered Architect and /or Engineer / 5' �/
Employing Electrician's Name..�.. 1� / Y L C rre T I F (- TR IL d x.
e NO... .,0. v (( `f" Soeest e $ u
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Master Electrician.
-+ _3, a �0
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L Metal Moulding
lectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida /' ermanent 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 employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. I ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'S
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. HEAT.
CONN.
SPACE
HEATER
STRIP
HEATER
TOTAL
CONTR.
LIST
/
G'• r cl _
CHECK
ENT.
SW.
DIST.
CAS.
SERVICE
TEMP.
SERVICE
PERM.
M OTORS
0.1 HP
MOTORS
1•5 HP
N EON
TRANS.
RADIO
TOTAL
CONTR.
LIST
/ 1
CHECK
r
F/L rea
Die MIAMI SHORES VILLAGE
Permit No
Owner's Name and Address
Amount of Permit $
ELECTRICAL INSPECTION DEPARTMENT
APPLICATION FOR ELECTRICAL PERMIT
Date ' ° )
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.
6urv1
(Signed)
(Signed)
No I `a r
Street .... /.: Jr,
Registered Architect and /or Engineer / 5' �/
Employing Electrician's Name..�.. 1� / Y L C rre T I F (- TR IL d x.
e NO... .,0. v (( `f" Soeest e $ u
Location and Legal Description Lot Block Subdivision
Street and Number where work is to be performed —No Street
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs No. of Stories
Master Electrician.
-+ _3, a �0
Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps
Underground
Type of Installation — Conduit Tubing B.X.L Metal Moulding
lectrical Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblations as an employer of
labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida /' ermanent 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 employ only such sub-contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
STATE OF FLORIDA,
COUNTY OF DADE. I ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
Cl. DATE - 195
0 PERMIT N° _ 1667 Contractor's
License No.
❑
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
B1
Subdi-
vision
Value of
Project $
u
Amount of
Permit $
This permit is granted to the contractor or builder named above to construc 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 11 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 cr in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY e6-•
Permit No
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
buliding during progress of work. o i-r
Owner's Name and Address O • N. Mart el No Street
Registered Architect and /or Engineer
Employing Electrician's Name L ewi s O. Wa ne r N 9 9 30 Street Central ,Blvd
Location and Legal Description Lot 1 5 Block 13 Subdivision Y
Street and Number where work is to be performed —No 101. N E• Street
State work to be performed and purpose of building (By Floors) Wire Residence
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
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE. ss '
APPLICATION FOR ELECTRICAL PERMIT
6
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
My Commission Expires
Date
102nd. St,
(Signed )
Electrical 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
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 employ only such sub - contractors, oo work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed). . f .. 4�-1
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: re•inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty
materials a /or workmanship.
SWITCH
OUTLETS
LIGHT
OUTLETS
PLUG
RECE'P'T'8
FIXTURES
NO. LAMPS
REFRIO.
OUTLET
IRON
OUTLET
RANGE
OUTLET
RANGE
CONN.
WATER
HEATER
W. H EAT.
CONN.
SPACE
HEATER
STRIP
H EATER
TOTAL
CONTR. LIST
15
15
28
15
1
1
1
/
.43)
2
a! V
CHECK
<3
/i11
/ V D
? -
7.s
ENT.
SW.
DIST.
CAD.
SERVICE
TEMP.
SERVICE
PERM.
SS -
M OTORS
O.1 HP
M OTORS N EON
1.8 HP TRANS.
RADIO
TOTAL
C LIST R'
1
/Y)
1
/jJ
1
/ o0
1
/ 05)
1 3 - Hp AC
/ � 1
CHECK
Permit No
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
buliding during progress of work. o i-r
Owner's Name and Address O • N. Mart el No Street
Registered Architect and /or Engineer
Employing Electrician's Name L ewi s O. Wa ne r N 9 9 30 Street Central ,Blvd
Location and Legal Description Lot 1 5 Block 13 Subdivision Y
Street and Number where work is to be performed —No 101. N E• Street
State work to be performed and purpose of building (By Floors) Wire Residence
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
Amount of Permit $
STATE OF FLORIDA, }
COUNTY OF DADE. ss '
APPLICATION FOR ELECTRICAL PERMIT
6
MIAMI SHORES VILLAGE
ELECTRICAL INSPECTION DEPARTMENT
My Commission Expires
Date
102nd. St,
(Signed )
Electrical 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
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 employ only such sub - contractors, oo work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed). . f .. 4�-1
Master Electrician.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
NOTE: re•inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty
materials a /or workmanship.