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ELECTRICAL PERMIT
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: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure 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 abs e of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Sigma Chc 12/15;03 ( A), Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowle ged before me this day of , 20 _, by , day of `- ( , 200V, by 1 f rpz who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. , n' • ...If/ entification and who did take an oath. Signature NOTARY PUBLIC: OTARY PUBLIC: Sign: Sign: Print: Pri t: / r Mt' . , . My Commission Expires: My Commission k ********************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *' �*•1A1PPPRIMI PPl n* * * * * * * ** (Certificate of Competency Holder) vt Expires August 15, 2006 esAnna M Mtenpouloe State Certificate or Registration No. Certificate of Competency No. Q m (b (Y& APPLICATION APPROVED BY: � f� Plans Examiner Engineer Zoning ITEM BATH TUB UNIT FEE 1 ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS r CENTRAL HEATING DISHWASHER 'Q5 RECEPTACLES 4/ A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS a DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP 3 APPLIANCE OUTLETS 40 ,-j PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN _4 . ABOVE GROUND TANKS LAUNDRY TRAY 1r WATER HEATER iv U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 FP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES A/C WINDOW REINSPECTION WATER SUPPLY TO: / AIR CONDITIONERS Pz5 A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS • HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4" TILE/RES. VIOLATION PUMP Z. ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. erxiv/ // (15 6 `,4S'y � As CATCH BASIN G� , * ,// V - 5 � DISCHARGE WELL — DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER /J e? FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) ) GAS PIPING Jr 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 Permit No B STATE OF FLORIDA, 1 COUNTY OF DADE. I SS. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. '7alte�° F. FrGde rich Jr. 1100 • e � b � , ?d+T.1 a2Qt ` .. la�rivo Owner's Name and Address No Street Registered Architect and /or Engineer L & T.I CO.INC 99 F.717. 166th VT. Employing Electrician's Name No Street Location and Legal Description Lot °" Block 01 Subdivision 0_ 0R S 450 T.E. 91st St. Street and Number where work _is to be performed —No Street State work to be performed and purpose of building (By Floors) New Buildinga Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ 2L / (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Fl da Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) f;?e<9.1,4-4J �C— Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Electrician. NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T's FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER .IX << ashes TOTAL CONTR. LIST IST ¶ 0 1L 8 25 11. •1 .' - 1 1 2 20.35 CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. M OTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RAOIO TOTAL CONTR. LIsr 150 arm 1--3—HI A/C 6.50 CHECK Permit No B STATE OF FLORIDA, 1 COUNTY OF DADE. I SS. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. '7alte�° F. FrGde rich Jr. 1100 • e � b � , ?d+T.1 a2Qt ` .. la�rivo Owner's Name and Address No Street Registered Architect and /or Engineer L & T.I CO.INC 99 F.717. 166th VT. Employing Electrician's Name No Street Location and Legal Description Lot °" Block 01 Subdivision 0_ 0R S 450 T.E. 91st St. Street and Number where work _is to be performed —No Street State work to be performed and purpose of building (By Floors) New Buildinga Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ 2L / (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Fl da Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) f;?e<9.1,4-4J �C— Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida Master Electrician. 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. /17 Permit No STATE OP FLORIDA, l COUNTY OF DADE. I SS. (Signed) MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date July 17, 1969 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. Jr * Owner's Name and Address Walter A Frederich No tte Street Registered Architect and /or Engineer Employing Electrician's Name L & m Electric Co* Inc* No 99 Location and Legal Description Lot # Block 1 Street and Number where work is to be performed —No 450 Street N0Ee 91st Street State work to be performed and purpose of building (By Floors) Residence New Building X Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ 3000 (Signed). . . . Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o 1igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Street N 166th Street Subdivision E1 Portal Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK -� ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP M OTORS 1.0 HP N EON TRANS. RADIO TOTAL CONTR. LIST 1Ja00 J CHECK -�- /17 Permit No STATE OP FLORIDA, l COUNTY OF DADE. I SS. (Signed) MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date July 17, 1969 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. Jr * Owner's Name and Address Walter A Frederich No tte Street Registered Architect and /or Engineer Employing Electrician's Name L & m Electric Co* Inc* No 99 Location and Legal Description Lot # Block 1 Street and Number where work is to be performed —No 450 Street N0Ee 91st Street State work to be performed and purpose of building (By Floors) Residence New Building X Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ 3000 (Signed). . . . Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his o 1igations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Street N 166th Street Subdivision E1 Portal Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No ___ /_ 5_ Z2 Application i Hereby made for the approval of the detailed structure herein described. This application is made in comp and all provisions of the Laws of the State of Florida, all or of Miami Shores Village shall be complied with, whether building during progress of work Owner's Name and Address_ Registered Architect and /or E Employing Plumber's Name Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. eer . MIAM SWURES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLIcc188ON o •.R PLUMBING PERM_ I '� Date tement of the plans and specifications herewith mitted f9lthe build ng or other ce and conformity with the Building Ordinance of Miami Shores Village Florida, ances of Miami Shores Village and all rules and regulations of th Building Div'sion erein specified or not A copy of approved plans and specifications must be kept at a434Lat No_ a.c Location and Legal Description Lot-___ -- -- -• Street and Number where work is to be perform State work to be performed and purpose of building (By Floors ) _ _ New Building ....... Remodeling— ____ -- _ -- - _ - _ Addition_-_- Street 21 . � , Block_._ Size Septic Tank__ _ - O .. • -- .- T eB r �- Type of Tank - - - -- •�' - -- - r Feet of Drain Tile -__ • _._ _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply. City—Vim _ -_ _ Si of Soakage Pit (Signed) _ Repairs_ Street Street-_ _ ub __ Capacity Gals. (Q No. of Stories _ PlLmb:ng In:pecto. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and I as 'om- 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 sit o the work such pub . - otice or no' ices as are required by the Act. The undersigned agrees to employ only such sub contractors, w., k to be o. - un• er this per nit, as are licensed by Miami Shores Village. the./ Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgu ents, personall 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 .acts therein by him stated are true. My Commission Expires Notary Public, State of Florida -- -' matet E: A re-inspection fee of $1.00 will be made when ouch re-inspection is made•necessary by improper notice for inspection, or faulty CLOSSTB BATH TUBS SHOWER! LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL F KTURES COHTR. LIST CHECK - - -- SEPTIC TANK SEWER GONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SWIM'S SYSTEM POOL CONTR, LIST r1 CHECK Permit No ___ /_ 5_ Z2 Application i Hereby made for the approval of the detailed structure herein described. This application is made in comp and all provisions of the Laws of the State of Florida, all or of Miami Shores Village shall be complied with, whether building during progress of work Owner's Name and Address_ Registered Architect and /or E Employing Plumber's Name Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. eer . MIAM SWURES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLIcc188ON o •.R PLUMBING PERM_ I '� Date tement of the plans and specifications herewith mitted f9lthe build ng or other ce and conformity with the Building Ordinance of Miami Shores Village Florida, ances of Miami Shores Village and all rules and regulations of th Building Div'sion erein specified or not A copy of approved plans and specifications must be kept at a434Lat No_ a.c Location and Legal Description Lot-___ -- -- -• Street and Number where work is to be perform State work to be performed and purpose of building (By Floors ) _ _ New Building ....... Remodeling— ____ -- _ -- - _ - _ Addition_-_- Street 21 . � , Block_._ Size Septic Tank__ _ - O .. • -- .- T eB r �- Type of Tank - - - -- •�' - -- - r Feet of Drain Tile -__ • _._ _ _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply. City—Vim _ -_ _ Si of Soakage Pit (Signed) _ Repairs_ Street Street-_ _ ub __ Capacity Gals. (Q No. of Stories _ PlLmb:ng In:pecto. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio s as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and I as 'om- 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 sit o the work such pub . - otice or no' ices as are required by the Act. The undersigned agrees to employ only such sub contractors, w., k to be o. - un• er this per nit, as are licensed by Miami Shores Village. the./ Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgu ents, personall 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 .acts therein by him stated are true. My Commission Expires Notary Public, State of Florida -- -' matet E: A re-inspection fee of $1.00 will be made when ouch re-inspection is made•necessary by improper notice for inspection, or faulty BUILDING ELECTRICAL PLUMBING >r Owner of Building Architect Contractor or Builder MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N? 3829 Work to be performed under this Permit Subdi- vision ' �Ir jYr l,. i r , oz - d o[» t' "milt. 194_ Contractor's License No. Legal Lot Bl. Description Address of Building 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• 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 regula- tions 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 Value of Project Amt. of Permit 04.T 10 .5 0 lo— aatS° 33 Fa d' 1 .35 1 �,�.,��✓ 1 .2 5 1.75 g. 1 .75 1 2 5 . 47.e,,/ 2 .50 3 .50 le a .00 T .00 T 3 ,/4 p f f 3 .00 26.85 T BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder CONTRACTOR OR BUILDER r MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N° 3829 Work to be performed under this Permit Subdi- vision Legal Lot Bl. Description Address of Building 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 o 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• 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 regula- tions 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. Value of Project in.- _his ."... Contractor's License No. Amt. of Permit BY AUTHORITY 194 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE � Date 1 3- ,"1 Job Address `- S O N Er Q I SF- Tax Folio 1 t -- 32 O� C- o © T Legal Description Historically Designated: Yes No '®83o Owner/Lessee / Tenant P- .Rc1 ,N 13,e_. 56 (( $ e" Owner's Address `7 Sb 9 CH Contracting Co.\ ` lA 23 5CcX ' Address 44 70 —474 Qualifier 1 ' " ej � SS# -7®— (o r. State # d O? Municipal # Competency # Ins. Co. , ®- Phone Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL P U MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 3D( lz. IV�I Square Ft. Estimated Cost (value) Signature of owner and/or Condo President Date Master Permit # �7 s/ - �3� '7 ? - cf:)p f\k 107 l WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and th all work w';1 be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named co tor to do e work stated. ignature of Contracto it Owner -Bui er Date Notary u. to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder My Commission Expires: My Commission Expires: FEES: PERMIT �'r O° RADON C.C.F. '' 0 NOTARY - BOND /O / TOTAL DUE Date / - 7 - 97 APPROVED: Zonin g Building B�� Electrical Mechanical Plumbing Engineering