1225 NE 93 St (6)Date Job Address f L= 9 3
E fib' Le T3 mot- W S ' L.c r
Legal Description a^ YkURE" (a 12) ¥'''/ - 6.3
Owner/Lessee / Tenant 1/A Se--/4 / C, L/ A) G L OQ
Owner's Address
Contracting Co.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Z-�s � L 3 S 3 MO12C.-S Phone 3 OS 7 S7- ? S
Qualifier & 'u i Ile ' tn.° 3 � L —�- r
State # SE P S90a, '7 M cipal # Competency #
/VA-
/V`
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRIC PEi B!N ECHANICAL O NG PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost (value) a)
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 that all work will be done in compli
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
No . ' :i. - to Owner . ' d/or on
ARY.P E OF FL
My Comnussro 1 ! � �5�� Ez
COMMISSION 10 CC811893
EXPIRES 5/3/2003
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
A M
Tax Folio ' 3 oS
k
l
Historically Designated: Yes
Address
Address
Address
Master Permit #
V r
Address 1 (o5 i . No_ 14,0
SS# & Phone(� 2 °'(J ✓ .
/e./7,& 6% }7 J •>
at Sign ture o ontractor or Owner- Builder
Ins. Co.
a s to Contractor!!o; Bpi
My Commission Expir s , `' ' q hrt cr
O O C „ : '_ ,
with all applicable laws regulating
C.C.F. J, D 0 NOTARY O '' BOND 3 n o 0 6
TOTAL DUE( d
Electrical
0/
Structural Engineer
APICATION FOR:
t( 1 New System
(4, Ropair
'APPLICANT:
AGE T:
MAIkINO ADDRESS: L N
tmilltum============================= = ======am
TO E COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
'SITE, PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
Sas! __============_____=__============= mm mtmsma=m=s miss[imist=ismmmsmmmmmmmiwmwmmm msmmS aemma sum
:PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED)
t G <p �. p r3 FL.JA•T 3ook if '
DATE OF
. W W. �' � " L OCK:
/ SUBDIVISION: ap0Y)L oRE 1 e G3 SUBDIVISION:
!PROPERTY ID #: [Section /Township /Range /Parcel No.) ZONING:
IPRO ERTY SIZE:
PRu ERTY STREET ADDRESS: / ;:,. ` , ;S n a S
b 4 T°
) DIACTIONS TO PROPERTY:
:Unit Type of
0
('
AP
DH
(St
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
. L (n/ (5L- g
Ayr
BUILDING INFORMATION
Establishment
Garbage Grinders /Disposals
Ultra -low Volume Flush Toilets
I CANT ' S SIGNATURE:
i /
[ -...) Existing System ( -•-) Holding Tank (.--) Temporary /Experimental
[ --3 Abandonment ( - - -) Other(Specify)
w,
(-16F
- ACRES (Sgft /43560) PROPERTY. WATER SUPPLY: [ ) PRIVATE (X) PUBLIC
5, 10/96 (Replaces HRS•H Form 4015 (Pegs 11 which may be used)
Number: 5744 - 001.4015.1)
i,. /. d.4 ) 1) //t• .. /
,:'+/ AA'o si be= o/
() RESIDENTIAL
No. of
$edroo s
( ) COMMERCIAL
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
TELEPHONE: _
.1 ) .,
DATE:
S,'oRLS f 33/3,?'
Building # Persons Business Activity
Area Sgft Served For Coa srci 1 Only
,..
(0) Spas /Hot Tubs (0) Floor /Equipment Drains 1
,( ) Other (Specify)
Page 1 of 3
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building '
MIAMI SHORES VILLAGE. FLORIDA
❑ �
❑
DATE
PERMIT N? 6251
0
Architect
Contractor
or Builder
Legal Lot
Description - � Bi.
Address of t a .
Building -
CONTRACTOR OR BUILDER
Work to be performed under this Permit
Signed-
7
?
Subdi-
vision
INSPECTOR
BY
AUTHORITY
At'
195
Contractor's
License No. Z/ 1
//
Value of 11 Amount of 2
Project $ 11 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 .-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.
In consideration of the issuance to me of this permit I agree to perform the work covered here der in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submi d the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant a ployee.
6