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1184 NE 91 Terr (5)ON 9 t 130 0 MIAM R S VIL1P TJ 8 BUILDING DEPARTMENT 305- 795 -2204 Cry 1 c Building Inspection Request Datet i Type Insp'n Pe . P1(01 Permit No. ' ` CO5 � 8� ,,� Name TC�Sle:� W - QSlhOr r Address 1 t S LI I\16 q 1 Ter K Company N4 I CI tL I do de. A-) f Phone # Inspection Date 0 Approved Correction Re- Insp'n Fee ( fr feJvv,a. FOR SECURITY PURPOSES, THE FACE OF THIS DOCUMENT CONTAINS A COLORED BACKGROUND AND MICROPRINTING IN THE BORDER Service America Network Inc. 515 N.W. 12th Avenue Deerfield Beach, FL 33442 ONE HUNDRED THIRTY SEVEN AND 40/ 100***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** PAY TO THE ORDER OF CITY OF MIAMI SHORES First National Bank of Chicago 0°00044064U0 t:0 ? 19 2 3 2 261: 94 L 29 L 311' DATE 04/09/02 70 2332/719 AMOUNT $ * * * * ** *137.40 t« • 44064 ' THE REVERSE SIDE OF THIS DOCUMENT INCLUDES AN ARTIFICIAL WATERMARK • HOLD AT ANGLE TO VIEW BUILDING 0 ELECTRICAL 0 --) PLUMBING 0 PERMIT ROOFING 0 (---) \ -:----. MECH 0 work to be t'"\ Owner of Building Architect - Contractor or Builder Legal Description Address of Building ( „ ' .7((?! /AL ( 7 0 7,,pfi---er Ito ( , 7 )r, (.7Z■64 Lot) .:( / 11 ft C/i' CONTRACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA y Date 50285 Contractor's License No. BY AUTHORITY 20 ) / performed under this Permit(Y ;/ ( AA of, 7( i')) /c _5( A to 777 3/-J) 1/ 3o 65 v()1 z 6‹ Subdi- 7.) 'Notary: visionP Sq. Ft.: Bond: Radon: Value of • - Amount of — 0 pro,. 41 ! ) 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- (=-• f• (INSPECTOR) BY In considerationrof the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulation, 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. 1 N Q O BUILDING `=---). PLUMB NG 0\ PERMIT ROOFING 0 MECH 0 Owner of I. Building � Architect Contractor or Builder Legal Description Address of Building (.c.41 - Lf L I' ot ' ) " IyU BI. MIAMI SHORES VILLAGE, FLORIDA L / 0,2 (ty.),956-) Date 50294 Contractor's License No. CONTRACTOR or BUILDER Work to be performed under this Permit r\ -( N L � ' )1 i)r --4 Iit,Ac vlc >> lt3aD50OI 0(-1-bb Permit' m ` c c) Subd EJ10 -ta Notaryi vision U Sq. Ft.: Value of Radon: L Amount of/ �� (, () Project $ 0 /) 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 whethe {.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�poybes. Sigtted/���;t�I _ /�S' —' (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 is assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY FOR SECURITY PURPOSES, THE FACE OF THIS DOCUMENT CONTAINS A COLORED BACKGROUND AND MICROPRINTING IN THE BORDER Service America Network Inc. 515 N.W. 12th Avenue Deerfield Beach, FL 33442 PAY TO THE ORDER OF CITY OF MIAMI SHORES First National Bank of Chicago ONE HUNDRED THIRTY SEVEN AND 40/ 100***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 0000440640 1:0 71,9 23 2261: 94 /29 /310 DATE 04/09/02 70- 2332/719 AMOUNT $ * * * * * * *137A0 44064 THE REVERSE SIDE OF THIS DOCUMENT INCLUDES AN ARTIFICIAL WATERMARK HOLD AT ANGLE TO VIEW Parcel Information FOLIO NUMBER: ADDRESS: MAILING ADDRESS: CLUC: PRIMARY ZONE: BEDROOMS: FLOORS: ADJ SQUARE FOOTAGE: YEAR BUILT: LEGAL DESCRIPTION: SALE O /R: 126221340 ASSESSMENT YEAR: LAND VALUE: BUILDING VALUE: MARKET VALUE: ASSESSMENT YEAR: LAND VALUE: BUILDING VALUE: MARKET VALUE: MIAMI -DADE COUNTY PROPERTY APPRAISER PUBLIC ACCESS 11- 3205 - 001 -0460 1184 NE 91 TERR SYDNEY GOLDSTEIN &W HILDEGARD , 1184 NE 91 TERR , MIAMI SHORES FL , ,33138 -3404 0001 RESIDENTIAL- SINGLE FAMILY 1100 SINGLE FAMILY RESIDENCE 2 BATHS: 2 1 LIVING UNITS: 1 1,929 LOT SIZE: 10,625 SQ FT 1954 5 53 42 WATERSEDGE PB 9 -141 E45FT OF LOT 22 & W4OFT OF LOT 23 BLK 2 LOT SIZE IRREGULAR OR 12622 -1340 0885 1 SALE 8 SALE 1985 SALE $ 75,000 MONTH: YEAR: AMOUNT: 2001 $ 87,975 $ 89,494 $ 177,469 2000 $ 76,500 $ 79,710 $ 156,210 ADDRESS: 1184 NE 91 TER Use scroll bar to view complete information. ASSESSED VALUE: HOMESTEAD EXEMPTION: WIDOW EXEMPTION: TOTAL EXEMPTIONS: TAXABLE VALUE: Home Page $ 119,010 $ 25,000 $0 $ 25,000 $ 94,010 ASSESSED VALUE: $ 115,544 HOMESTEAD EXEMPTION: WIDOW EXEMPTION: $ 0 TOTAL EXEMPTIONS: $ 25,000 TAXABLE VALUE: $ 90,544 $ 25,000 Owner Search Address Search Folio Number Search Page 1 of 1 ... /esrimap.dll? Name = PublicAccess &Cmd= SearchAddressT &STNum= 1184 &STPDir= NE &ST111 /15/01 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 6/15/2005 Applicant: BRENDA Owner: WESTHORP JOB ADDRESS: 1184 Contractor MIAMI DADE AIR Local Phone: 305 - 969 - 2300 Parcel # 1132050010460 NE 91 Signed: (INSPECTOR) Signed: (Contractor or Builder) Mechanical Permit Permit Number: MC2005 -86 WESTHORP BRENDA TERR Contractor's Address: 10463 SW 114 ST Legal Description: 5 53 42 WATERSEDGE Fees: FEE2005 -8208 FEE2005 -8209 FEE2005 -8210 FEE2005 -8211 FEE2005 -8212 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $122.50 $2.40 $0.80 $3.07 $3.00 $131.77 Total Fees: $131.77 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 12/5/2005 Construction Value: $3,500.00 Work: INSTALLATION OF ONE 2 TON NC UNIT& THREE SUPPLY DROPS BY: Page 1 of 1 PB 9 -141 E45FT OF LOT 22 & W4OFT OF LOT 23 JUL 0 8 PAID ...-i c # 2.49 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. Owner's Address t 4 N E q ( City M vANM, _ `hc tS State Contractor's Company Name Code Enforcement $ Total Fee Now Due $ 1 (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION N 7 ; .'r r Master Permit No. FBC 2001 JUN 7 ?5 an. Permit Type (circle): Building Electrical mbi g C echanica ) Roofing Owner's Name (Fee Simple Titleholder) gait. s Tenant/Lessee Name Phone # Job Address (where the work is being done) \ 124 elk City Miami Shores Village County Miami -Dade Zip 3 ..51 Is Building Historically Designated YES NO M !1( C'ontractor's Address _J cas -(13 1 '33 C--1 ('ity tv1 ` A-M l State . r(.-- Zip . - 1 L Qualifier f-'k tL lz_ L elm State Certificate or Registration No. CAC . QS Certificate of Competency No. Architect /Engineer's Name (if applicable) Phone # $ Value of Work For this Permit i - 3, Soo. v 0 Square Footage Of Work: Type of Work: ❑Addition [Alteration ❑New ❑ Repair/Replace �� El Demolition Describe Work: t�S 4-`t O Owi= 1�.^ �Ut) t"ti jC Ji -i1�tr S.,Q ft C1 rg3 * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ / Permit Fee $ I t v CCF $ .'�� CO /CC Notary $ Training /Education Fee $ Technology Fee $ 3 c 1 Scanning $ 3 eti.) Radon $ r Zoning i Bond $ Structural Plan Review. $ Permit No. roc-0G _ g� Phone # 00C10 zip 3 -) Phone # S- 9 69 - ,i r Pi) Bonding Company's Name (if applicable) 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 CONDITIONERS, ETC OWNER'S AFFIDAVIT: 1 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 will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 , by day of who is personally known to me or who has produced chc 05/13/03 The foregoing instrument was acknowledged before me this Contractor , 20 , by who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************************* * ** * * * * * * ** * * * * ** * * * * * * * ** * * * ** * * ** *4 4 *44 *4# *+krt*4.0-6 * * * ** * * * * * * ** ** ** APPLICATION APPROVED BY: Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) ..."1" DRINKING FOUNTAIN SERVICE SIZE IN AMPS DUCT WORK 4 40(10 o FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE [ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MJTORS QVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 IP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEM3LIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEM?ORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 If COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES - A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMAING POOL OUTLETS COWERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING . ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL CONTRACTOR Name , VtLv i'- C. License No. EC0000680 Address 3,1,g/ / /Jf ^ /�iT - FE Orr7/ 0 4v vv/ Re-", ' ° • 3_?06s' Telephone 93 e/ 9 7g" !�U Fax Qualifier Name Michael E Ellis PROPERTY OWNER Name ‹: -. V/t/r� e; 6 8 ST'� /ij/ Addss drrreee//g , Ni 9 T - "Afa7YJ/ .S/f0/ -A. S - .2 3/..? ir Home Telephone 305 7_5 /G6 Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair ✓ Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERT IIT FEES $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine $ Zoning Review $ (sq.ft. = x/1000 x .1.60) SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE � y/ 1 ..eok ( '/ (.1.005 /sq.ft.) ( 0.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION O CONDO ASSOCIATION APPROVAL (Attach) O BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 - 2207 • FAX (305) 756 - 8972 • http : / /www.miamishoresvillage.com Step 1. Job Address: PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other p .1os9 / / , , €r Address , Apt. Chg. Contractor Renewal Revision Extension Supplement Reinspection PERMIT CHANGE (✓ ) ARCHITECT Name Address License No. Telephone Fax Master Permit No. Ati-17 Subsidiary Permit No. INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. $ubmit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION //407'71 i'7/ S/fpl7r5' City Tax Assessed/Appraised Value State Folio Number /( / — Description of Work Re- connect a /e. & disco (s) cV 9/ 4/4• 6. . ..7 PERMIT APPPLICATION 5oag9 33/ .? Zip Lot Block Subdivision PB PG Zoning Linear Feet Current Use of Property �! / 0,=; vTiQ6 Square Feet Units Floors Proposed Use of Property ;...-Fr/e-- Value of Work /00 Bldg Value Tenant Information Flood Zone Base Floor Elev. ENGINEER Address Name License No. Telephone Fax ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton - Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16-20 Ton Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. A/C Central, Tons QTY. Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 2 INIPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECI'LD FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STA Print ame Sworn to and subs SEAL: OF MIAMI -DADE STATE ry Public - State of Horida 4:;!!! . Notary PubNe State et Ronda = JOSE LUIS AVILA Commission # CC 725765 Comm. Expires Mar. 18, 2002 y of Personally known OR, Produced Identification Type of Identification Produced: P19- SEAL: Signa ure of Contractor / Qualifier Print Name Swom to and subscribed before me this /U0 Uday of Signature of Notary Public - State of Florida )()( PERMIT APPLICATION I -DADE 6 Ca P I 'I ri : /pa Personally known OR, Produced �d�ntrfi2 tiib7� Co �rcC. Type of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: CONTRACTOR Name & yn, -169 .a61)s r� /,t- Address //8 IVF ff s 7" -• •4 -- .G• 33/ ..f Name Business Telephone Fax License No. CA0026405 Repair Address 300 /1/7'$, 7 /4tg i /�f'''7 el $e-l1, -- 33'6 S Telephone p7e/..,../ /00 Fax Relocation of Structure Qualifier Name Steven J Sarko Foundation Only PROPERTY OWNER Name & yn, -169 .a61)s r� /,t- Address //8 IVF ff s 7" -• •4 -- .G• 33/ ..f Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund.; $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) Cl OTHER (Specify & Attach) o $ .75 (sq.ft. = x/1000 x ¢.60) SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE / / .L ?. vl (¢.005 / sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. processing of your application, you may be asked to submit additional information. APPLICATION Job Address: •P7 /fir 9/ e- Address Folio Number // - P /. Q Z14,0 Lot ID - / / Subdivision Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other 1PC,k a 5 PB q PG 141 PID)O Tzz Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name Address License No. Telephone Fax Master Permit No. Co 2 v C Subsidiary Permit No. City State Description of Work r!if /5f.• OC/T S1 /STrs ? 3tnn Tram. 1 2SFF.R Zoning Linear Feet Units Square Feet PERMIT APPLICATION of Floors During the 7 -5gw TTP036D10.0A TWE036P13FB Value of Work 3.6 Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER 1 Name Address License No. Telephone /9 Fax ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Dryer Vents, Number of Outlet, Wall Ventilation, Cost Service, Temporary Air Handler, Tons A/C Central 4 -7 Ton Piping, Flammable Liquid Fire Pump Outlet, Switch Fire Sprinkler System Signs A/C Central 8 -15 Ton Bath Fan - Vented, # Fixture - Fluorescent Pressure Vessel Oven Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs AJC Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTY. AJC Central, Tons Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Ventilation, Cost Solar Water Heater Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Fixture Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, P' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF OF MIAMI -DADE Signature of Own V1 Print NaAe Sworn to and subscribed SEAL: otary Public - State of Honda Wary Public, State el et norms JOSE LUIS A\ /ILA Commission # CC 725765 Comm. Expires Mat. 18, 2002 Personally known OR, Produced Identification day of ftldsi,�+v.3. Type of Identification Produced: SInatur tor / Qualifier SEAL: Personally known PERMIT APPLICATION STATE O - • r , COUNTY OF MIAMI -DADE Print Name Sworn to and subscribed before me this ti00 day of /9 Ze,c) . Signature of Notary Public - State of q rida " - r ' 86.54 � • r C.. 80 •. 26, 203 . Q?;iiag Co., L)_ OR, Produced Identification Type of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: CONTRACTOR Name ?� EW — TA 51 1 11 Name " AM 1 _tA.DL I2 A ( Home Telephone License No. C. P O S 2 0.5s- I Fax 305 , 44 x00 , 5 y y 0 Address (aa - 1 So 1 33 c_ MtANI. FL 3 ( '26 Repair Telephone J Fax 30S, act.. 54 f Qualifier Name ` , t(c I ( p /z -. &R � A Demolish PROPERTY OWNER Name ?� EW — TA 51 1 11 Address q r q k . Tux MtAM' Skazs Fc 33134 Home Telephone Business Telephone 305_ O S e i 33 - (:)(,(1 O I Fax 305 , 44 x00 , 5 y y 0 TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior / Repair Alteration Interior ✓ Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'I Detachment Other Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) Cl OTHER (Specify & Attach) PERMIT FEES SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: ' ?4 k) E `` a M V4 A Shores Address Apt. City Folio Number Lot Subdivision Tenant Information Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. II- 3aos- bo1 - ©4(00 Block PB PG Current Use of Property RL5i Proposed Use of Property PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit No. State Value of Work 3r SOO.00 33) 3? Zip Description of Work +i4 IPr%\ J 5-k t c� -krtz_ S.)epI -j Drop Zoning Square Feet Linear Feet Units Floors Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT CHANGE (✓ ) ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPE Minimum Fee QTY. TYPF, Dryer QTY. TYI'I? Outlet, Appliance QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Cooling Tower Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Paint Booth Fire Pump Ventilation, Cost Outlet, Switch Air Handler, Tons _ Signs Ductwork, Cost of • 4040 A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) Process/Pressure Piping A/C Central 16-20 Ton Fixture Light Bath Fan - Vented, # Parking Lot Lights Fireplaces, Number of Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New NIECHANICAL TYPE Minimum Fee QTY. . 111E Condensate Drain QTY T'iig ::, 1. Generator Q TvI'I Refrigeration, Tons QTY A/C Central, Tons __ 1 Cooling Tower - Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Filter Replace Ventilation, Cost Pool Piping Air Handler, Tons _ 1 Ductwork, Cost of • 4040 Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Cap - Water Gas - Appliance Bath Fan - Vented, # Pump, Domestic Fireplaces, Number of Pressure Vessel Cap - Sewer PLUMBING TYPE A/C Condensate QTY TYPE: Drains, Roof QTY. TVI'I : Miscellaneous Fixture QTY. .11 Soakage Pit QT1 Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosin , - ontractor. STATE • FL • • IDA, Signature p Owner f2AU2-■ - 1 - 61 Print Name Swom to and subscribed before me this Signature of Notary Public - State of Florida l0 day o — 3 - 0 1, 1 r..- SEAL: t MY andolph Casanas COMMISSION DD259135 OGRES • October 14 2007 g.' INC Personally known OR, Produced Identification Type of Identification Produced: tom] L`r L e sc-e� SEAL: PERMIT APPLICATION STATE OF FLO i , CO -DADE Signature ontractor ! ualifier ik A ‘ e—i (14.e_41 Liz RA Print Name �. Sworn to and subscribed before me this day of Ju1� ao‘ls Signature of Notary Public - State of Horida g: r:: Randolph Casanas ;._ MY COMMISSION # 00259135 EXPIRES October 1 `• %�• 4 2007 d: BONDED THRU TROY FAIN INSURANCE. INC Personally known 4/ OR, Produced Identification Type of Identification Produced: Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: