PLUMBINGDate
Legal Description
Owner / Lessee / Tenant
Owner's Address
2ierk.--741„;;
Qualifier 7Y] / $ '- i SS# Phone 7sf -eyzi
State 4fr 0.>-?-5 7 Municipal # Competency # Ins.Co. $7 72 4477
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Contracting Co.
WORK DESCRIPTION F20.4 )\""
Square Ft. Estimated Cost(value) 4 ��
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 compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
Abo
S
n P— "t3�F
* COMMISSION NUMBER
;;e Q CC360191
. oFfLo cit° MY COMMISSION *EXP.
RADON
Notary
My Comm
** *
PEES: PERMIT
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address i ( 7 3 445'
1 t 1 2 - ' Tax Folio 1/ awl a44
r /69 vck 2 P84¢ 4,3
G Al2 1 -- /017,0
/4 4- G
OY/7 f
esident
Zoning Building
Mechanical Plumbing d-
Address
1`
Notary as to Con
My Commission Ex
* * * * *
C.C.F. R NOTARY
1
Master Permit 16 36 ` l 73
Phone 7-
Signature of Contractor or Owner-Builder
Date:
\ ilk
y _. _.
• a tP ;.ro ;'
• BARBARA ANN FUGAZZI
• A • i * COMMISSION NUMBER
Q CC360191
MY COMMISSION EXP.
(c‘ OF*1. ° WAR. 1.91998**
TOTAL DUE 115 'tit
Fire Other
a Electrical
I1ngineering
Date • -• - +�� _ 7-
Application is hereby ma a 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.
Owners Name and Address
Registered Architect and /or En ineer
Employing Name .__ 16
Size Septic Taal_ - 07�
Feet of Drain Tile 7S
Nature of Water Supply: City—Well.
Amount of Permit $
STATE OF FLORIDA, I
es.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Lot- cy� 131oelr Subdivision
Street and Number where work is to be performed —No 4)--7...4 ! 1.71 9P Street._.. _...__.. --
State work to be performed and purpose of building (By Floors)__ -.._ _--______-- _._-_
New Building___._ _ __.._._..---._.. Remodeling_.__-_ --_._.-.__ Addition__._..__ __.._.. Repairs
No .
_Type of Teak _- C
Feet of Tank or Drain Field from Well.
Size of Soakage Pit
(Signed)- . M
(Signed) J -�
No. of Stories..
Plumbing Inspector.
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 com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him In the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Muter Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
materials
NOTE: re-inspection fee of $1.00 will be made when w>ch re is made.neoe:tary by improper notice for inspection, or faulty
kmanahip.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINK[
LAUNDRY
Tugs
URINALS
CATCH
BASIN
FLOOR
DRAIN
--
DRINKI NO
FOUNT' NS
. TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
BWIM'0
P001.
CONTR.
LIST
_
CHECK
Date • -• - +�� _ 7-
Application is hereby ma a 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.
Owners Name and Address
Registered Architect and /or En ineer
Employing Name .__ 16
Size Septic Taal_ - 07�
Feet of Drain Tile 7S
Nature of Water Supply: City—Well.
Amount of Permit $
STATE OF FLORIDA, I
es.
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Location and Legal Description Lot- cy� 131oelr Subdivision
Street and Number where work is to be performed —No 4)--7...4 ! 1.71 9P Street._.. _...__.. --
State work to be performed and purpose of building (By Floors)__ -.._ _--______-- _._-_
New Building___._ _ __.._._..---._.. Remodeling_.__-_ --_._.-.__ Addition__._..__ __.._.. Repairs
No .
_Type of Teak _- C
Feet of Tank or Drain Field from Well.
Size of Soakage Pit
(Signed)- . M
(Signed) J -�
No. of Stories..
Plumbing Inspector.
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 com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him In the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Muter Plumber.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
materials
NOTE: re-inspection fee of $1.00 will be made when w>ch re is made.neoe:tary by improper notice for inspection, or faulty
kmanahip.
Application is hereby made for the approval of the detailed statement of the plans and specifications herewit If 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.
Permit No.___ 1 . 3 (° I
Owner's Name and Address
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ilvoge
Registered Architect and /or En ' eer
Employing Plumber's Name .1t11)ecie.Cl�r _
Location and Legal Description Lot .d :.t Blo�� 2 Subdivision_ cr _ -h_ e t - - --
Street and Number where work is to be performed -No WI: 92 Street
State work to be performed and purpose of building (By Floors )-j h_s '
New. Building - - - -_ _ -_ Remodeling___ —___._ __ Addition__
Size Septic Tank_ Type of Tank_
Feet of Drain Tile.______ __ _____.._Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City-Well. eLrY
Amount of Permit $
therein by him stated are tellibTAMY t URIC STATE OP RK xT 1AROI
- MY bormmu ON Mites MAY 1, 1973
arav wsa fitiNAt•>t><t04
My Commission Expires
(Signed
Date__
I -
e. No._ _.____.______ . Street-_.
No.. —. _ -- __ -_ -- Street_ --
Repairs No. of Stories
Capacity Gals
Size of Soakage Pit
(Signed) -r
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob ': ons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perin Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em . yed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the si e w• such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub -contr t pe • ed under this permit, as are
Beamed by Miami Shores Village.
STATE OF FLORIDA, ( is.
COUNTY OF DADE. J
Before me, the undersigned ' •.,, ority, : n • / • blic, duly authorized to administer oaths and take acknowledgments, personally appeared
Muter Plumber.
to me well known, and who, bein' me first : my sworn, u • oath deposes and says that he is the_ ,4 1 d./ 41 JY�LTl/Y.
of the above described construction, that he has carefully read the foregoing application, and that a did sign the same, and that all facts
Notary Publi State of
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
Tues
SHOWERS
LAVA.
TORIES
SINKS
SLOP
SINKS
LAUNDRY
awes
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
C
LIST
LIST
2
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE'
TRAP
SOLAR
NEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
r1
i4'TNe
N7a,
CONTR.
LIST
CHECK
� _
Application is hereby made for the approval of the detailed statement of the plans and specifications herewit If 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.
Permit No.___ 1 . 3 (° I
Owner's Name and Address
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ilvoge
Registered Architect and /or En ' eer
Employing Plumber's Name .1t11)ecie.Cl�r _
Location and Legal Description Lot .d :.t Blo�� 2 Subdivision_ cr _ -h_ e t - - --
Street and Number where work is to be performed -No WI: 92 Street
State work to be performed and purpose of building (By Floors )-j h_s '
New. Building - - - -_ _ -_ Remodeling___ —___._ __ Addition__
Size Septic Tank_ Type of Tank_
Feet of Drain Tile.______ __ _____.._Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City-Well. eLrY
Amount of Permit $
therein by him stated are tellibTAMY t URIC STATE OP RK xT 1AROI
- MY bormmu ON Mites MAY 1, 1973
arav wsa fitiNAt•>t><t04
My Commission Expires
(Signed
Date__
I -
e. No._ _.____.______ . Street-_.
No.. —. _ -- __ -_ -- Street_ --
Repairs No. of Stories
Capacity Gals
Size of Soakage Pit
(Signed) -r
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his ob ': ons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Perin Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors em . yed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the si e w• such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub -contr t pe • ed under this permit, as are
Beamed by Miami Shores Village.
STATE OF FLORIDA, ( is.
COUNTY OF DADE. J
Before me, the undersigned ' •.,, ority, : n • / • blic, duly authorized to administer oaths and take acknowledgments, personally appeared
Muter Plumber.
to me well known, and who, bein' me first : my sworn, u • oath deposes and says that he is the_ ,4 1 d./ 41 JY�LTl/Y.
of the above described construction, that he has carefully read the foregoing application, and that a did sign the same, and that all facts
Notary Publi State of
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made by improper notice for inspection, or faulty
materials and /or workmanship.
SECTION
BY
DATE
Zoning
Electrical
Mechanical
Plumbin•
1113. 440. —
/ / – / =Sa`
Fire
r/I
Public Works
Structural
Building Official
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
❑ FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
PERAIIT 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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ FIRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$
(¢.005 /sq.ft.)
(¢.01 /sq.ft.)
( x .60) x/1000
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
TOTAL $
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVA L
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
QTY.
TYPE
Dryer
QTY.
TYPE
Outlet, Appliance
QTV'.
TYP1:
Service Repair
QTV.
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
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
IVIECHANICAL
TYPE
Minimum Fee
QTY. TYPE
Condensate Drain
QTY. TYPE
Generator
QTY. TYPE
Refrigeration, Tons
QTY.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WaWWin. 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.
T YPE
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 3
R
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
RECEIVED AND REVIEWED BY: DATE:
Page 2
IMPORTANT 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 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'
accordance with
Choosing a r. t •• or.
(305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
akti pS Q'7
nt Name
worn to and subscribed before me this of12 ) '7
SEAL:
Signal o Nota Public - State of Florida
04.61 PO4, Angela M Becker
. 4 My Commission D0150048
% n ,/ Expires November 15.2008
Signature of Contractor / Qualifier
Print Name
Swom to and subscribed before me this day of
Signature of Notary Public - State of Florida
SEAL:
PERMIT APPLICATION
Personally known OR, Produced Identification (/ Personally known OR, Produced Identification
Type of Identification Produced:RD of Identification Produced:
'PROPERTY OWNER
Name • u beA. T. "MA ......pso•■,
Address
%'?-? 5 me ct' . sr.
Home Telephone 365.- 75'.( (vs
Business Telephone 305 .. 75-6- 0 (O v
Fax 3(Yr — 7 a- "e0 0
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
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 submit-
ted along with this permit application.
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.
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
APPLICATION
�b Address:
c. ?3 #JE
Address
Folio Number
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
Sr 1/
Apt. City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No. /' c ' c:9 6
Ta Assessed/Appraised Value
c(Aofe5 p- .
State
PERMIT APPLICATION
35(SS
Zip
1 escription of Work I3+ 1( f(tx
Lot Block Sytf�l vfi� (v$ Pi *tpe. 03Aie� t 'Ape.* 1 .
Zoning Linear Feet
Square Feet Units
X Floors
alue of Work t 2 cc> -a o Bldg Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 11/4/2002
Applicant: MARIE THOMPSON
Owner: THOMPSON MARIE
JOB ADDRESS: 1273 NE 92 ST
Contractor
Local Phone:
Parcel # 1132050270260
Z-S;
Total Fees: '$A—
Total Receipts: $0.00
?c7-
D
Y bick zuu 5, o o Permit Status: Approved Permit Ex tion: 5/3/2003
Work: INSTALL FLEX TYPE SPRINKER
In consider :l of the issuance
with the pl s, drawings, state
myself, my agent, servants
Plumbing Permit
Permit Number: PL2002 -298
Contractor's Address:
Legal Description: 5 53 42 BAY LURE PB 44 -63 LOT 15
Construction Value:
Page 1 of 1
BLK 2 LOT SIZE 75.000 X
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
` - fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further co dition 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 regulatio s 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, sery ants .r employees.
Sign / d: (INSPECTOR) BY:
f this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
pecifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
REG x:01 110802 1311 MC001 002654 CASH $85.00
(Contractor or Builder) BY:
r-