1480 NE 102 ST ArchiveBUILDING
❑
ELECTRICAL
❑
PLUMBING
❑
ROOFING
❑
Owner of
Building
4rchitect
, ontractor
pr Builder
Lot
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 3001
BI
DATE 195
Contractor's
License No.
Work to be performed under this Permit --
Subdi-
vision
ress of Value of j I Amount of
ling Project $ Permit $
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
or in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
ings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
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
ed is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ining 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
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
Ling thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
i this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY
AUTHORITY a a-
BUILDING
❑
ELECTRICAL
❑
PLUMBING
❑
ROOFING
❑
—
❑
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE. FLORIDA
DATE_
PERMIT NQ 2'7 `s- `�.5..�0 ctor s
LJ- 11 ;11e Ng
Bl.
<<
Work to be performed under this Permit e
Subdi-
vision
Value of
Project
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in it
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance wi
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be re
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
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances ai
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsi]
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 a]
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY
AUTHORITY
BUILDING
❑
ELECTRICAL
❑
PLUMBING
❑
ROOFING
[].
Owner of
Building
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 2940
r
Work to he performed under this Permit
o
Contractor's
License No.
Legal Lot II Subdi-
Description B1. vision
Address of - Value of I Amount of
Building - _ Project Permit $
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
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be rev(
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 tl
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances anc
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibi
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 anc
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Vi
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY
AUTHORITY
BUILDING
ELECTRICAL
❑
PLUMBING
❑
MIAMI SHORES VILLAGE. FLORIDA
(PERMIT N° 6281
ROOFING ❑
Work to be performed under this
Owner of '
Building •s�-
Architect
Contractor
or Builder
Legal Lot
Description --
Address of
Building
Subdi-
vision
DATE 195
Contractor's
License No.
Permit f. -k : . #`•> ?� jF .C.
Value of _ (� Amount of
Project $ ' /'` ��
Permit
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 f9s_a thorn knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawing i the,statemenid or spe catf'bns and that he assumes responsibility for work
done by his agents, servants or employees. > ff
' A
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 . j'Is permit I assume, responsibility for all work done by either, MY elf, my agent servant or employee.
C TRACTOR OR BUILDER BY AUTHORITY
BUILDING
❑
ELECTRICAL
❑
PLUMBING
El
ROOFING
❑
MIAMI SHORES VILLAGE, FLORIDA
PERMIT NO@ 2842
Owner of
Building
Architect
Work to be performed under this
Contractor
or Builder 7,,
Legal Lot
Description
Subdi-
vision
DATE 195
Contractor's
License No.
Permit
Address of! +^; .m Value of Amount of c
Building s '- , '° G Project $.'' a r e'."` I Permit
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 i
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulation
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 wor
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 and regi
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
cepting this permit I assume responsibility for all work done-by either, myself, my agent, servant or employee.
_ _
CONTRACTOR OR BUILDER BY AUTHORITY E
In
BUILDING
❑
ELECTRICAL
❑
PLUMBING
❑
ROOFING
❑
FJ
Owner of
Building .
Architect
Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
PERMIT
Work to be performed under this
DATE 195
Contractor's
License No.
Legal Lot Subdi-
Description — Bl. vision
Address of Value of Amount of
Building Project Permit $
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 applicati
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any play
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at ai
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
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulatio
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 we
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 regulatio
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In <
icepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY
AUTHORITY e
BUILDING
❑
ELECTRICAL
❑
PLUMBING
❑
ROOFING
❑
Owner of
Building
Architect .
Contractor
MIAMI SHORES VILLAGE, FLORIDA
Date — -_
PERMIT N° 8223 Contractor's
License No.
Work to be performed under this Permit—.-
or Builder EI t
r
i
19_`_
Legal Lot Subdi-
Description I Bl. vision
Sq. Ft.
Address of Value of Amount of
Building Project $ (( Permit $ —
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 applica-
tion 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 respon-
sibility for work done by his agents, servants or employees.
Signed _ (INSPECTOR) BY --
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.
CONTRACTOR or BUILDER
BY
AUTHORITY
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 iImust be kept at building during progress of the work.
S'
----- - - - -1-
Owners Name and Ad ress._..:._....... g/417' . l e r! - - - - -_ No../,�..�� -. ' S ��Z
,r� tr _ / .........
Registered Architect an /or Engineer... = - -- - . ---/' --- _---------- -----,,_- - - - - -- .-.------.-, c..------------------------•-------------------------------- .------- .------- ••- •-- • -• -• --
Name and address of It ensed contractor.."41440
Location and legal d ption of lot to be built on:
Street and Number where work is to be done......... .
State work to be done and purpose of building (by
for no other purpose.
New Building- ..- ..- .._- ! ............. Remodeling ..... - ...... ._........... Addition.- ..-- Y------ .- _-- - -- Repairs .........-- .--- _........ No. of Stories ...................... ....
To be constructed of .... ....................... Kind of fgundation_ .. ..- ........................ ........_• Roof Covering ............... ........
i"f s
Estimated Total cost of improvements $- . -___ -- . -- ��? . ----------- - ..„Amount of Pennut $ ..... .._ ............ .................- ..._.....:_..
Zone cubage
Cubage_.___.__... . -.- .... - .... _ ....... .- .- .._-_ .......................
Distance to meat 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
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 complied with the rovisions 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 wo k such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su]ntractors, on work to be�fonned under this
permit, as are licensed y Miami Shores Village. �' '„ / � / /
( Signed )
STATE OF FLORID
COUNTY OF DADE.
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, beinng by me first duly sworn, upon oath deposes and says that he is the - .............. - __.._..__.. _.._ _------- .----- _---- -- - - -.
d construction, that he has carefully read the foregoing application, and that he did sign the same, and that -- all facts
of the above ascribed
therein by him stated 'e true.
Permit No-4k, e" -__ _. Date.._ � � � � � ,L% _ Read, Sworn to and Subscribed before me.
Disapproved - -. - r -_ .-
_...-
r' Notary Public, State of Florida
Of
B g Inspector My Commission
Chairman
Member __..,___.__._
Member ......
- - --
Council Approved..._. .
NOTE: A charger
the Planning Board.
A re- inspection fei
materials and /or worlao
PLANNING
Member- -- -------- ------------ _- ----- -. -------- . -.._-
Member_ -- - - - - -- _ ________.____.. - _-_.-- . -..... .._ -_ --
Member____._.__ ___ -_._._ _. _._ ..._._..- -.... - -.._.
Disapproved..- .. - - -_ -. __ ------------------------------------------------- .._.Date
$1.00 will be made for making corrections or changes to this application after approval has been obtained from
o£. $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.. �
Date . - - - -.= I':!?— '�— F
Application is hereby rude 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 Sham Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinauca of Miami Shares Village and all rules and regulations of the Building Division
of Miami Sham Village shall be complied WiMth.1 a fied or not. A mpy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address 0 StIreet..
Registered Architect and/or
EM19ying Plum 's Nwi
-7 �7
Lantim &a Law Desalption Lot. v B1oolt Subdivision....... _ ..
Street and Number where work is to be Street
State work to be performed and purpose of building (By Floors)_
Now Remodeling Addition._—... Repairs-__ of Stories.
Size septic MA . � Ty Of Team - ---.---capacity
A
got or Field from Well--
Fed Of Drain
Tilfl�41ty --Size of Soakage Pit-
Nature of Water upply; C
0 0
Amount of Penniftt (S . ...........
Plumbing inspector.
The undersigned applicant for this Wilding permit does hereby certify that he understands a "s his obhp0Wn&*.&an employer of labor
Law the Florida workmas compensation Act, being Section 5966, Compiled of F1 Penn t Supptefi;amt, and N% com-
plied with the provisions thereof, and will require similar compliance from all IS Su employ him In the wort- to be
performed under this permit; and will post or cause to be posted for inspection on Of such p lic notice or ;;r
required by the Act. The undersigned agrees to employ only such sub-contractorlo to pert under this t, as an
licensed by Miami Shares Village,
STATE OF FLORIDA, OIL
COUNTY OF DADE. I
Before me, the undersigned authority, a notary public, duly an&orized to administer as& r"us- take acitnowledgments, personally appeared
to me well Imawn, and who, being by me first duly sworn. upon 04* d?oSSS and says that he is the---
1 0
of the above described construction, that he bas carefully read the resolaff application. and that he did sign the same, and that all
therein by him stated are truce
my CQ=nW=3i""i= Notary PuW State of Flo"
NOTE: A re- inspection fee of $140 Will be snadS Whoa M& M4§WWM if madraaowne3 by how go, no" ltsapeliion, or
materish and/cc wadinausW
13AIN
SkOw"s
LAVA•
SINKS
SLOP
LAumvity
URINALS
CATCH
FLOOR
DRINKING
TOTAL
CL.10*19TO
TUNS
TORIKIII
SINKS
Tuns
BASIN
DRAIN
FOUNT*NS
FIXTURES
CONTR.
L.15T
CHECK
SEPTIC
StW91%
DRAIN
SOAKAGE
GRKASC
66LAN
DEEP
SPRKLX.
SWIM'G
TANK
CONN.
FIELD
PIT
TRAP
HILATIN
W91.1.
SYSTEM
POOL
CONTR.
LIST
cmacm
Size septic MA . � Ty Of Team - ---.---capacity
A
got or Field from Well--
Fed Of Drain
Tilfl�41ty --Size of Soakage Pit-
Nature of Water upply; C
0 0
Amount of Penniftt (S . ...........
Plumbing inspector.
The undersigned applicant for this Wilding permit does hereby certify that he understands a "s his obhp0Wn&*.&an employer of labor
Law the Florida workmas compensation Act, being Section 5966, Compiled of F1 Penn t Supptefi;amt, and N% com-
plied with the provisions thereof, and will require similar compliance from all IS Su employ him In the wort- to be
performed under this permit; and will post or cause to be posted for inspection on Of such p lic notice or ;;r
required by the Act. The undersigned agrees to employ only such sub-contractorlo to pert under this t, as an
licensed by Miami Shares Village,
STATE OF FLORIDA, OIL
COUNTY OF DADE. I
Before me, the undersigned authority, a notary public, duly an&orized to administer as& r"us- take acitnowledgments, personally appeared
to me well Imawn, and who, being by me first duly sworn. upon 04* d?oSSS and says that he is the---
1 0
of the above described construction, that he bas carefully read the resolaff application. and that he did sign the same, and that all
therein by him stated are truce
my CQ=nW=3i""i= Notary PuW State of Flo"
NOTE: A re- inspection fee of $140 Will be snadS Whoa M& M4§WWM if madraaowne3 by how go, no" ltsapeliion, or
materish and/cc wadinausW
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 building or other structure herein
blodescribed. 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.
Owner's Name and
; -.- `Z c) m f
D)X
Location and lwal description of lot to be built on:
Lot Block 1- Subdivision
ktreet and Number where work is to be done, tj C
c.,gt'ate work
New Building Remodeling Addition
—
7b be constructed of Kind ojfoundation Roof Covering
t-" Estimated 'Ibtal cost of improvements $ � �'�J Amount of Permit S
Zone cubage required Plan Cubage
Distance to next nearest building
Maximum live load to be borne by each floor
of Building
I hereby submit all 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 obligatons as an employer of Labor under the Florida Aorkmen 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 WorkAD be perfor
under this permit, as are licensed by Miami Shores. Village. L/
Remarks �Signedl �—X°
STATE OF FLORIDA
COUNTY OF DADE. as'
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 f ^ appli cation, and that he did sign the same, and that all facts therein by him stated are true.
Permit No ° / Date I ' `" M� Read. Sworn to and Subacn'bed before me.
Disapproved_ Date —
Notary Public. State of Florida
ISdgnedl
Building Inspector My Commission Expires
Chairman
Member
Member
Council Approved
PLANNING BOARD DATE
Member _
Disapproved
Date
q
NOTE: A charge of 525.00 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 $25.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty materials andior workmanship. —
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 bufl&
in
9 or other structure herein described. is application is made in compliance and conformity with the Building Ordinimm of Miami
Slim 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.
Owner's Name and Address--------- - - - - -- - ------------- ------ N..,14(l�_-AS69L 17!
Registered Architect and/or Engineer...__ ---- ---- - - ---- --------- - ------- - -- ---- ---- ---- -- - * - -------- ------ 7 — - — ---------- ** ---------------
Name and address of licensed contractor_____..,04&_C 7 r e - -
-- - - - -------
Location and legal description of lot to be built on:
Lot -- ---- Subdi vision-- - - - - --
TStreet and Number where work is to be / e a- lt�p ____
State work to be done and purpose of building (b floors) ---., ---- - -------------- - - - -- - ------------------------
- - — - --------- - - - - - --
for no other purpose.
New Building — - -------- - ----- Remodeling------ ___..___-- ____ -__ Addition----- -------- --- --- - - - - -- Repairs ---------------- - ----- - No. of Stories.__.-
To be constructed of---- ..----------- - - - -__ Kind of foundation - -- - ------ - ----------------------- ---------------------- - - Roof Coveri ng_----------------------- _-- - - - - --
Estimated Total cost of improvements — — ------- - - Amount of Permit $ ----- - ------------
Zonecubage - - --------------- - -------- ---------- - - - - -- -Plan Cubage — - ----- - ----- - -- — --- - -- - -__-_ -
Distance to next nearest of Building Lot_ - - - -__
Maximum live load to be home 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
besent — — --- - -- - ------ - -------------- -- - -------- - -- — -- — ------ - ---- — -------
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 Lth 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 ublic notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be 'K orm under this
permit, as are licensed by Miami Shores Village.
Remarks---- (Signed) —
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 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 stated are true.
Permit Date Read, Sworn to and Subscribed before me.
Disapproved z7 ___ -7 Date ------------
(Signed) ......... ----- -- -- - - - - --
Building Inspector
P NING BOARD
L --- --- -----------
Chairman- - ------------- - _ -------- - - --- — — - - - - -------- - - - - - -------------- -
Member — ----- --- ----- - - - - --
Member . ----------
Council Approved — - --- - ------------- - - - ---------- - ---- - - - ------------ - ----- Date
---- - ---------- - ----
Notary Public, State of Florida
My Commission Expires --- - ---------------_------- -
--- - ---- DATE
Member
Member ------------ ------ - -
Member
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.