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1170 NE 102 St (2)UII.DJNG CAL UMBING i er of �; uil I Architect N ontractor 1 I J , { �� } ` ... for Builder .. Legal Lot II BI. 1 Description Address of Building i e 4,� . t - x MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 9131 Work to be performed under this Permit I CONTRACTOR OR BUILDER Subdi- vision Value of Project $ 1 r t r , y DATE t 195_ Contractor's License No Amt. of Permit BY AUTHORITY i 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 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. Signed: '' t ' �. (49t INSPECTOR „-'• In consider on of the issuance to me of this permit I agree to erform the work covered hereunder in complia ce with all ordinances and regulations there 'n 'ct confor with the plans, drawings, statements or specifications submitted to the grope authorities of Miami Shores Village. i g p su e r o bibi)ly for all work done by either, myself, my agent, servant or employee. . PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 Date (2 Job Address /'7t) �E f /pl. a rTax Folio Legal Description / 1 '/f 4/ .g �-;G i Owner /Lessee/Tenet �/1 ut' " ar.,,, 74 I Master Permit # P2 ° ft 4 5 • T lFa ' /G 14 4 /M • es i „..k ! /Dee �,G' Address /993 - /41 E c t (: ""/"3 Owner's Address Permit Type (circle one): BUILDING ELECTRICA WORK DESCRIPTION: / k� Contracting Co. Qualifier State # Municipal # Competency # Historically Designated: Yes No SS# Phone - ' IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, ERE WILL BE NO INSPECTION. RE— INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. PLUMBING MECHANICAL ROOFING Square Ft. Estimated Cost (value) /9 4 ` ) 0 • 757 - r Ins. Co. 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 ANY 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 all disciplines. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work stated. otary + to Ow r an +'r on .o President My Commission Expires >9 495a•53n.Q• o FEES: PERMIT F 0 66 RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F L6999L03 1; } aennN Noisswmoo L) , S, td3 039 30NV 4 y - _ yylON WO Date Signature of Contractor or Owner Builder N OFFICIAL NOTARY SEAL 6 ANGELA M BECKER t•,..; } 0 COMPASSION NU ) o i • C786697 ,ri►c ry as to Ide My Commission Expires p 5D na. e k-M ocuY1 . Date ate (DO NOTARY 5 ' 0 BOND 3 tt 7 . v( TOTAL DUE Electrical Structural Engineer e: Each block reoresents 10 feet and 1 inch = 40 feet. s ew Site Plan submitted b Plan App o ed 2 " By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERT t. - ` Permit Application Number 'Z ;;:-1 (Z 7 -1 Z •, DaliAr Wtii • PART II - SITEPLAN L I • Not Approved ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -002 - 4015 -6) Date ¶f 3/ i2 County Health Department Page 2 of 4 SRTY ID #: t / - ?70 -6/c1) 3E COMPLETED BY ENGINEER, HEALTH UNIT TIDE REGISTRATION NUMBER AND SIGN AND PERTY SIZE CONFORMS TO SITE PLAN: [ AL ESTIMATED SEWAGE FLOW: 390 • HORIZED SEWAGE FLOW: BSTRUCTED AREA AVAILABLE: 9 CHMARK /REFERENCE POINT LOCATION: ;NATION OF PROPO SED SYSTE "tTE EVALUAT M SITE IS ] fE SUBJECT TO FREQUENT FLOODING: YEAR FLOOD ELEVATION FOR SITE: 0 SOIL PROFILE INFORMATION SITE 2 IL PROFILE INFORMATION SITE 1(�'ti`1 Texture th unsell Color to t o t o t o t o to to to YES [ ] GALLONS GALLONS SQFT 1 4015. 10196 (Replaces HRS -H Form 4015 (Pape 3) which may be used) '•., k Number: 5744- 003 - 4015 -1) PERMIT # C ' STATE OF 'FLORIDA DEPARTMENT OF HEALTH � I ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION / 1 AGENT: 71 I .�J Cf e 4 .„),,,....,/ .„),,,....,/ fi e . BLOCK: i,u SUBDIVISION: )' f l 11 S``G ) _../..t. - [ Section / Township /Range /Parcel. No . or Tax ID Number] EMPLOYEE, OR OTHER QUALIFIED PERSON. ALL ENGINEER'S MUST SEAL EACH PAGE OF SUBMITTAL. • _ NO NET USABLE AREA AVAILABLE: O HE. }L. AC R -TABLE 2] PER DAY [RESIDENCES -TABLE 1 / PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] _ UNOBSTRUCTED„..AREA RE 4 zi SQFT %7 /0 /j ^i / I IJ , (INCHE AB (OV_j3] BENCHMARK /REFERENCE POINT j( WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEEM�TTOTTHE�FOLL(WINGEFEA�O MINIW R: I J FT DITCHES /SWALES:/ FT tFACE WATER: I,Q PRIVATE: fy'� FT NON- POTABLE: FT FT LIMITED USE: __ C► FT POTA WATER LINES: 2.Z_ FT (LD PUBLIC: FO FOUNDATIONS: [LDING FOUNDATIONS: F T PROPERTY LINES: Z [ ] YES [v1 NO FT MSL /NGVD 10 YEAR FLOODING? [ ] YES [.� FT MSL /NGVD SITE ELEVATION: g/ USDA SOIL SERIES 'BSERVED WATER TABLE: +'y A�II1r INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] •— INCHES [ ABOVE BELOW ] E %ISTING GRADE. ( IGE WATE WET TABLE WATER TABLE ELEVATION,: MOTTLING: [ ] YES [ NO DEPTH: INCHES IIGH WATER TABLE VEGETATION: [ ] DEPTH OF EXCAVATION: 2 1-- INCHES :OIL TE %TURF /LOADING. RATE FOR SYTTREENCSHIZI`G� BED [ ] OTHER (SPECIFY) 1RAINFIELD CONFIGURATION: [ ] tEMARKS /ADDITIONAL CRITERIA: DATE: 15 3 P age 3 of 3 Ai- STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ X ]Repair [ ]Abandonment APPLICANT: Armesto, Laura' LOT: 5 BLOCK: 176 PROPERTY ID #: 11- 3205 - 019 -0130 R EPAP [ ]Holding Tank [ ] Innovative Other [ ] Temporary [ NA ] AGENT: RF0038620, Foster Roy PROPERTY STREET ADDRESS: 1170 NE 102 St Miami FL 33138 SUBDIVISION: Miami Shores No. 1 [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] CENTRAX #: 13 -SC -13054 DATE PAID: FEE PAID : RECEIPT . OSTDSNBR : 02 -1663- -R SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECI TIME PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T A N K D R A I N F I E L D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ 0 ]SQUARE FEET SYSTEM TYPE SYSTEM : [y " .) STANDARD [ N ] FILLED CONFIGURATION: 1/ N ] TRENCH [ y . ] BED LOCATION TO BENCHMARK: Top of Bottom Floor, ELEVATION OF PROPOSED SYSTEM SITE [ 2.3 BOTTOM OF DRAINFIELD TO BE [ 4.1 FILL REQUIRED: [ 0.0 ]INCHES OTHER REMARKS: THIS PERMIT IS NOT FOR ADDITION(S). *Existing 900 gl. septic tank to remain. *Install 300 sq.ft. of drainfield. *Invert elevation to be no less than 6.77' NGVD. *Bottom elevation to be no less than 6.27' NGVD. SPECIFICATIONS BY: Icaza, Carlos APPROVED BY: Icaza, Carlos DATE ISSUED: 6/3/02 DH 4016, 03/97 (Obsoletes previous editions which may not (Stock Number: 5744- 001 - 4016 -0) [oatda cons_4016 -11 900 ]Gallons SEPTIC TANK 0 ]Gallons 0 ]GALLONS GREASE INTERCEPTOR CAPACITY 0 )GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS THE SEPTIC TANK SHALL SE PUMPED Afars A SOLID DEFLECTION DEVICE INSTALLED OH 7HE OUTLET TEE 10.40' NGVD. ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT ] [ FEET ] EXCAVATION REQUIRED: [ 22.0 ] INCHES TITLE: TITLE: Engineer I Dade be used) MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y [0 ]DOSES PER 24 HRS # PUMPS( 0 THIS PERtI!1 13 NOT FOR A?'7` j'. ) :.I.a: INVERT V,'Ta 3 7 t ITIT 3l Of ►DI? afl 9El.W El- VAATS :1H 6 EXPIRATION DATE: 9/1/02 ) [ N ]MOUND [ N ] [ N ) [ BELOW BENCHMARK /REFERENCE POINT CHD Page 1 of 2 APPLICANT: AGENT: V -� STATE OF FLORIDA DEPARTMENT OF HEALTH DIPOSAL SYSTEM ONSITE CONSTRUCTTION$IN8 E MID FIHAL APPROVAL DEPTH TO LID t/ FILL / EXCAVATION MATERIAL 1 11 *ILL AMOUNT 111 PILL TEXTURE 1 11 1 tzCAVATION DEPTH 18 1 AREA REPLACED 1 11 1 REPLACEMENT MATERIAL • PROPERTY ADDRESS: --J /• LOT: BLOCK: i SUBDIVISION: !��:! ''' -L PROPERTY ID #s CHECKED [z] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE s a=s=s TANK INSTALLATION r, [01] TANK SIZE [1](11:___ [ [02 ] TANK MATERIAL [03] OUTLET DEVICE • - — . [04] MULTI- C8A1BERED [ Y /! [05] [06] [07] [08] [09] [ 1 OUTLET FILTER /V/- [ ] LEGEND N I ,: [ l WATERTIGHT �.�- -� [ LEVEL IY / f [ DRAINFIELD INSTALLATION .7, /� (10 ] AREA [ 11 l _' , L _l [ Z ] . QPT [ 1 [11) DISTRIBUTION BOX HEADER - [ l [13] NUMBER OF DRAINLINES 'S [ ] (13] DRAINLINE SEPARATION 5,_,_ [ ] [14] DRAINLINE SLOPE -!_;-- (15] DEPTH OF COVER/2, /1 W I j J (16) ELEVATION [ABO� BELOW : , - [ ] (17 ] SYSTEM LOCATION />-- -- -- [ ] 1 DOSING PUMPS 1191 AGGREGATE s I ZE j '( 1 1 (20] AGGREGATE EXCESSIVE FINES [ 1 1 AGGREGATE DEPTH / ']_ 1 1 [ 1 1 ] [ 1 IRON Or VIOLATIONS / REMARKS: f .! 44-[ *1'PROVgkDISAPPROVED] s [lirPROVED /DISAPPROVED] CED 144" larspious Editions Nay Bs Ussd) 1 ] 1 ] OR [40] [41] [42) RULE AND PT 1: Applicant PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department PERMIT NO.r) 1 ` % ✓`. DATE PAID s ,' - -s - ° FEE PAID: 7 i ; r'' CJ RECEIPT # s Li ^ /`') .. MUST BE CORRECTED. SETBACKS [27] SURFACE WATER [28] DITCHES A) ) '" - [19] PRIVATE WELLS A/ !.! [ 30) PUBLIC WELLS /V FT [31] IRRIGATION WELLS' r'i • FT [31] POTABLE WATER LINES /0 FT (33) BUILDING FOUNDATION. ./• FT [34] PROPERTY LINES /% [35] OTHER FT FILLED./ NOWND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS [43] MAINTENANCE AGREEMENT (44] BUILDING AREA [45] LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING / ,� (47] CONTRACTOR �✓ ` `' '' �- �- �� [48] OTHER =. ABANDONMENT i l (49) TANK PUMPED �=/ - �. [50] TANK CRUSHED & FILLED f4. \ CND DATE : ( DATE/ Page 2 of 3 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 6/19 /2002 Applicant: LAURA Owner: ARMESTO JOB ADDRESS: 1170 NE Contractor MR C'S SEPTIC TANK Local Phone: 305 -651 - 7859 Parcel # 1132050190150 Permit Status: Sign Fees: FEE2002 -3441 FEE2002 -3442 FEE2002 -3443 FEE2002 -3444 102 Description Building Fee CCF Notary Fee Buildier's Bond Total Fees: Plumbing Permit Permit Number: PL2002 -154 ARMESTO LAURA ST Contractor's Address: P 0 BOX 693239 Legal Description: MIAMI SHORES SEC 8 REV PB 43 -67 LOT 5 BLK 176 LOT SIZE Amount $80.00 $1.20 $5.00 $300.00 $386.20 Construction Value: $1,900.00 Page 1 of 1 Total Fees: $386.20 Total Receipts: $0.00 Approved Permit Expiration: 12/16/2002 Work: TO REPLACE DRAINFIELD If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. 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 condi '.n 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 regul. 'ons • -rtaining 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, se. n or : ployees. TOR) BY: In cons of t e 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: aj - PAY TO THE ORDER OF FOR MR: C'S SEPTIC & DRAIN, INC. OPERATING ACCOUNT P.O. BOX 693239 305-651-7859 MIAMI, FL 33269 -0239 //1/ev 63- 8413/2670 DATE dk Awm-e reol_ze, Washington Mutual Nut.• • r•••, M,.tn X1 3a ^∎ t.t;, •19'' SI' ••: I n,anc,a, Cen._r 1719 :7^ •:N '1 I 0 ' ;AR 7VY) M•nm, r .l1!,9 ' • C,,t SY •'ce j-4 0547311' 1:267084 L3 LI:383.110 3084 211100 'DOLLARS u 5473 $ yam • L Drumm 1 4.. frie C !ris i tirit i tte ucvm RIARA S1JRA'EZ RRMESTO 4290 Skj.12.fir ." RES r•IcilONS r DiIIVEP LICENSE NUMBEIL N.. I 1 - 02 - 88 8652-537-48-910 7494 OPERATOR Rfik> 09,1700 SAFE DRIVER 4 3 trill 6 New Building Amount of Permit $ l0_1QQ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 1Z3 7 Date._ 16_, 1970 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. Owner's Name and Address__.Mx.B- a_.Y8.a;Ifn Miai►_eI __._-..-___. - _ -_.. No. _ __ Street Registered Architect and /or Employing Plumber's Name _Braoks_S.zinkler Co NO o .a_ 54th St Street. _.__--_- - Location and Legal Description Lot Bloch Subdivision Street and Number where work is to be performed —No 1170 N .E . 102 S treet St State work to be performed and purpose of building (By Floors)__drilLwe_L1_d_ nla- t8L1_._SptiUhiI1$_-- 4y.St.Cm Remodeling ___ __ Addition._________ Repairs.._ No. of Stories. Size Septic of Tank_ Feet of Drain Tile______ _______ _.Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: of Soakage Pit ( Signed )---- - Capacity Gals. (Signed) - Plumbing Ins(iector. Notary Public, State of Florida 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 5988, Compiled General Laws of Florida Permanent Supplement, and has mu- 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 undersigned agrees to employ only such sub- contractors, on work to perfo . ed r this perinit, as are licensed by Miami Shores Village. er Plumber. E) 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, 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. 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 TUBE LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBS U URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'N6 TOTAL FIXTURES CONTR. LIST - CHECK ___,, SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL Spr cyst CONTR. LIST CHECK 1 1 New Building Amount of Permit $ l0_1QQ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 1Z3 7 Date._ 16_, 1970 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. Owner's Name and Address__.Mx.B- a_.Y8.a;Ifn Miai►_eI __._-..-___. - _ -_.. No. _ __ Street Registered Architect and /or Employing Plumber's Name _Braoks_S.zinkler Co NO o .a_ 54th St Street. _.__--_- - Location and Legal Description Lot Bloch Subdivision Street and Number where work is to be performed —No 1170 N .E . 102 S treet St State work to be performed and purpose of building (By Floors)__drilLwe_L1_d_ nla- t8L1_._SptiUhiI1$_-- 4y.St.Cm Remodeling ___ __ Addition._________ Repairs.._ No. of Stories. Size Septic of Tank_ Feet of Drain Tile______ _______ _.Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: of Soakage Pit ( Signed )---- - Capacity Gals. (Signed) - Plumbing Ins(iector. Notary Public, State of Florida 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 5988, Compiled General Laws of Florida Permanent Supplement, and has mu- 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 undersigned agrees to employ only such sub- contractors, on work to perfo . ed r this perinit, as are licensed by Miami Shores Village. er Plumber. E) 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, 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. 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. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Approved Correction Re- Insp'n Fee Time Date Type Insp'n Permit No. Na Al Address / / 1 l 0 / n �-( /op. s Company Phone # 1 For Inspector:. J (J "�N.y � to MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Time Type Insp'n Permit No. Na � Q[,UN '�-./ Address 11 e) D i /5&. Company 1 a_s Phone # 65!9 For Inspector: Approved 6 Correction Re- Insp'n Fee o Dat Type Insp'n Permit No. Name Address Company Phone # For Inspector 7/ 0 a \ P & Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B ilding Inspection Request O I� (Itity( T.