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Pool ApplicationMIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 P Z 1O Buildin Inspection Requester �y Date Time ' t -/L) Type Insp'n Permit No. Name - Address co Co t�. , �c Company _ lit, O d -- Phone # 50 9 7 {') D 7,z-) For Inspector: Approved Correction Re- Insp'n Fee I / ` Name & Date BUILDING ELECTRICAL PLUMBING Owner of Building _ Architect Contractor or Builder Legal L BI. Description Address of Building MIAMI SHORES VILLAGE, FLORIDA DATE PERMIT N9 2'936 Work to be performed under this I'ermit Subdi- vision Value of Project Amt. of Permit 194 Contractor's License No. This permit is granted to the contractor or builder named above td c onstruct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thet eto and with the understanding that the work will be performed in compliance With any plans, drawings, statements or specifications that may have been s ibmitted 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 he ordinances and regulations pertaining to the work covered hereby whet ler shown on the plans-oz . drawing -or in' the etatetttentrto °sppcificaybns 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 perfo' m 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 stibmitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done b! either myself, my agent, servant or employee. CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Lot Work to be performed under this Permit C MIAMI SHORES VILLAGE, FLORIDA PERMIT N? c 510 Bl. DATE Value of Project A Subdi- vision ' Amt. of Permit //4 that he assumes responsibility for work done by his agents, servants or emi loyees. igned: By /I( Contractor's `? "'fir License No. f' AUTHORITY 1941_ Address of Building if/ fir s _ This permit is granted to the contractor orbuilder named above to <onstruct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thei eto and with the understanding that the work will be performed in compliance • with any plans, drawings, statements or specifications that may have been s ibmitted 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 or finances 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 es INSPECTOR In consideration of the issuance to me of this permit I agree to perfo In the work covered hereunder in compliance with all ordi ces and regula. tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authoriti of Miami Shores Village. In accepting this permit I assutrte responsibility for all work done by either myself, my anent, servant or employee. CONTRACTOR OR BUILDER BY or r Lot gl Subdi- Ori vision ) f Value of Amt. of Project Permit • BUILDING ELECTRICAL PLUMBING Owner o Building Architect Contract or Builde Legal Descripti Address Building MIAMI SHORES VILLAGE, FLORIDA DATE 194 PERMIT N9 2613 Work to be performed under this 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 s ibmitted 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 or finances 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 statement or specifications and ram he assumes responsibility for work done by his agents, servants or e loyees. Signed• ... By INSPECTOR In consideration of the issuance to me of this permit I agree to perfo -m the work covered hereunder in compliance with all ordinances and regula- tions pertaining thereto and in strict conformity with the plans, drawings, statements . specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I die resp nssibili f f) all work done by either my gent, servant or employee. r CONTRACTOR OR DUILDER BY Contractor's License No. ,. AUTHORITY A- v BUILDING ELECTRICAL PLUMBING Owner o Building Architect Contract or Builde Legal Descripti Address Building MIAMI SHORES VILLAGE, FLORIDA DATE 194 PERMIT N9 2613 Work to be performed under this 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 s ibmitted 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 or finances 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 statement or specifications and ram he assumes responsibility for work done by his agents, servants or e loyees. Signed• ... By INSPECTOR In consideration of the issuance to me of this permit I agree to perfo -m the work covered hereunder in compliance with all ordinances and regula- tions pertaining thereto and in strict conformity with the plans, drawings, statements . specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I die resp nssibili f f) all work done by either my gent, servant or employee. r CONTRACTOR OR DUILDER BY Contractor's License No. ,. AUTHORITY or r i o Lot " ' gl Subdi- Ori vision f ° Value of Amt. of Project Permit ; i BUILDING ELECTRICAL PLUMBING Owner o Building Architect Contract or Builde Legal Descripti MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 2384 Work to be performed under this Permit t ' Address 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 whetter 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 emrloyees. Signed• By INSPECTOR In consideration of the issuance to me of this permit I agree to perfoi m 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 DATE J Contractor's License No. AUTHORITY 194 BUILDING ELECTRICAL PLUMBING Owner o Building Architect Contract or Builde Legal Descripti MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 2384 Work to be performed under this Permit t ' Address 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 whetter 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 emrloyees. Signed• By INSPECTOR In consideration of the issuance to me of this permit I agree to perfoi m 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 DATE J Contractor's License No. AUTHORITY 194 JOB: AD: BUILDING • • ELECTRICAL : • • PLUMBING' . ▪ WORK • • ; • DONE BY: • • • • • • • • • • • • • • • • • • • The following is ready fc.r Inspection: Inspector's Report: REQUESTED : WILL BE READY • • • • • • Permit No. Location and Legal Description Lot__ Owner's Name and Address ors Amount of Permit $_ - -` MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date — ��`-- I 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 comp! Lance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ord nances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with )erein specified or not. A copy of approved plans and specifications must be kept at building during progress of wor �Lr E . V ss. My Commission Expires No hda / z---•L Registered Architect and /or Engineer t. 1 Employing Plumber's Name No. __ ;1 __Q Notary Public, State of Florida Street — / y�J_� -'- -• Street_ t - -i — F I � �, A Block Subdivision ________________�_— ___________ Street and Number where work is to be performed - -No. ttt —1 ' ` ' C ca 6___RQ! Street _ State work to be performed and purpose of building (By Fl )ors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank . Capacity Gals.___________ —___ — Feet of Drain Tile_____— _— ______. —__ —__ Dist. Feet of Ta ik or Drain Field from Well Nature of Water Supply: City —Well C_� � 1 Size of Soakage Pit (Signed) — — — -- — — — — -- — — — Plumbing Inspector. The undersigned applicant for this building permit does 1 ereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar coi ipliance 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 pc ;ted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ on y such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) ?QQ_/K? ___ $_ Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. 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 re; d the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. • 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. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS :LOP ;INKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT CREASE TRAP 5 )LAR H', ATER DEEP WELL SPRKLR. SWIM'G SYSTEMy- POOL CONTR. LIST CHECK Permit No. Location and Legal Description Lot__ Owner's Name and Address ors Amount of Permit $_ - -` MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date — ��`-- I 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 comp! Lance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ord nances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with )erein specified or not. A copy of approved plans and specifications must be kept at building during progress of wor �Lr E . V ss. My Commission Expires No hda / z---•L Registered Architect and /or Engineer t. 1 Employing Plumber's Name No. __ ;1 __Q Notary Public, State of Florida Street — / y�J_� -'- -• Street_ t - -i — F I � �, A Block Subdivision ________________�_— ___________ Street and Number where work is to be performed - -No. ttt —1 ' ` ' C ca 6___RQ! Street _ State work to be performed and purpose of building (By Fl )ors) New Building Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank . Capacity Gals.___________ —___ — Feet of Drain Tile_____— _— ______. —__ —__ Dist. Feet of Ta ik or Drain Field from Well Nature of Water Supply: City —Well C_� � 1 Size of Soakage Pit (Signed) — — — -- — — — — -- — — — Plumbing Inspector. The undersigned applicant for this building permit does 1 ereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar coi ipliance 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 pc ;ted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ on y such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) ?QQ_/K? ___ $_ Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. 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 re; d the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. • 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. MIAMI SHORES VILLAGE Permit No.. Date___ Application is hereby made for the approval of the detailec statement of the plans and specifications herewifli sub d for the building or other structure herein described. This application is made in comp iance and conformity with the Building Ordinance of iami 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. Owner's Name and Address M_AJS__11.,___.t�A.rY?�!t = No Street Registered Architect and /or Engineer _144/VQ4 C Employing Plumber's Name ___.�e__� __ -t1_ J_____.________ti No. 4i_.E Street____ d 4..k . • ___ x Location and Legal Description Lot_____ ___tf'_ ______ ____ _________Block 7 Subdivision& CcteTi11C __Mss. Fh Street and Number where work is to be performed—No E Street Q __ ___________— _�_______ State work to be performed and purpose of building (By F oors) New Building Remodeling____ Addition Repairs No. of Stories 1 Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. t.<- TY Size of Soakage Pit Amount of Permit $___ PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank . _Capacity Gals Dist. Feet of T nk or Drain Field from Well (Signed) 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 Sectiol 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar cc mpliance 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 pDsted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ c sly such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary publ.c, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, III on oath deposes and says that he is the of the above described construction, that he has carefully 'ead 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 wh 'n such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CLI 2 / CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP •`•OLAR F EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. IST LIST CHECK MIAMI SHORES VILLAGE Permit No.. Date___ Application is hereby made for the approval of the detailec statement of the plans and specifications herewifli sub d for the building or other structure herein described. This application is made in comp iance and conformity with the Building Ordinance of iami 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. Owner's Name and Address M_AJS__11.,___.t�A.rY?�!t = No Street Registered Architect and /or Engineer _144/VQ4 C Employing Plumber's Name ___.�e__� __ -t1_ J_____.________ti No. 4i_.E Street____ d 4..k . • ___ x Location and Legal Description Lot_____ ___tf'_ ______ ____ _________Block 7 Subdivision& CcteTi11C __Mss. Fh Street and Number where work is to be performed—No E Street Q __ ___________— _�_______ State work to be performed and purpose of building (By F oors) New Building Remodeling____ Addition Repairs No. of Stories 1 Size Septic Tank Feet of Drain Tile_ Nature of Water Supply: City —Well. t.<- TY Size of Soakage Pit Amount of Permit $___ PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank . _Capacity Gals Dist. Feet of T nk or Drain Field from Well (Signed) 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 Sectiol 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar cc mpliance 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 pDsted for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ c sly such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary publ.c, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, III on oath deposes and says that he is the of the above described construction, that he has carefully 'ead 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 wh 'n such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Date 6—) I Miami Shores Village Building and Zoning Department Attention: Building Official SWIMMI'VG POOL OWNER'S CERTIFICATION I certify that I am tie legal owner of the property described as F4.LA►L ' _ , located at 3C4' e - Ali 1 Am 1 34lut2-ES { Fi . . In accordance with Section 33- 12(f), Code of Metropolitan Dade County, I certify that 1 understand and agree that the swimming pool to be constructed at the ayove address cannot be used or filled with water until a separate pernit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting an approved barrier prior to final inspection and use of the pool. Legal Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. Date Job Address Tax Folio Legal Description ,4 ,o 7 A E '7 Owner's Address 3‘4 Contracting Co. .t hwJ LS t �4� .27v Qualifier I� ��r� N:4 Li/S'T.i WORK DESCRIPTION /' € L Signature of owner � as to Owner and/or Condo s ent My Commission Expires: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE or Condo President Date Sk"..J Date 1%` P4 B TERI LONG ar r G n COMMISSION III CC633971 4 0, II MI ,. EXPIRES MAR 27. 2001 BONGED THROUGH itf1F F`'' ATLANTIC BONDING CO.. INC. FEES: PERMIT a RADON C.C.F. APPROVED: Zoning Building Mechanical Plumbing Historically Designated: Yes Owner/Lessee / Tenant A2 G X AinefL u /its/'/ /4- Master Permit # L -( (. SS# Square Ft. Estimated Cost (value) 5) Phone 4 ? P O o yf� a ¢NJ� Address / / S''U 671,4 / a c/E' 3.izc / ` Phone 9f V - -- 76 / (5 Competency # Co. Address Address State # Municipal # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL cL1JMBIN)G MECHANICAL ROOFING PAVING FENCE SIGN 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 LEFORE 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 o' 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 AFFID VIT: I certify that all the foregoing informrtion is accurate and that all work will be done in compliance with all applicable laws regulating co stru tion and zoning. Furthermore, I authorize: the above -named contractor to do the work stated. Signature of Contractor or Owner - Builder No ot as to Contractor or Owner - : ' er My Commission Expires: ,,PW TERI LONG ac 711 l COMMISSION IP cf633971 con N. EXPIRES MAR 27. O 411 • BOND®TNROUGN 4 0F F` ATLANTIC BONGING CO.. INC. Date Date NOTARY BOND Electrical TOTAL DUE "° Engineering NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PIRMIT NO. TAX FOLIO NO. II" l STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: 6M u' ' l ip ��'J S L / / 4 « J -1 / 2. Description of improvement: J(. // H!M ,.'71 3. Owner(s) name and address: '" /9 ti/D e c2 //}744/4 93 "=f/ .S ,7 c—Ca Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: Ne 4 r rec4S 'S �'7S 2 L- 5. Surety:(Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified/ / Notary Public Print Notary's Name My Commission Expires: Signature o1 Owner 1 Print Owners Name /"91e,.< L iv, 1/r''f-C1-•=4*i l Sworn to and subscribed before me this (0 day of l�'tJ E ti�`i Ga ROBERT E. JOHNSON !g) ' COMMISSION # CC 323192 - _ - ' : 3 7 OF Tve 7.224.s pAyt On RORIDA, COUNTY OF CADE iiQu�`a}y CERTIFY 211 e al this i. o Oruo cob of flip 04; dhis offfoa co E` 0.0 C n I Lit I,(.1 1,S Prepared by:� /�1} thv ) ( 1P4 Address: AA-LA .s Z6 12301.52 2/93 MIAMI SHORES VILLAGE Permit No., €> Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name ______>.„. Location and Legal Description Lot__ /-'__�____'______. PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed st Itement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in complian:e and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordina ices 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. No.---r - - -aZ Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floo s) New Building Remodeling Addition No Street Capacity Gals.___ Size Septic Tank_ Type of 7 ank Feet of Drain Tile_____ _____________— _______ ___ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City-4.--Well — _____..__________.Size of Soakage Pit (Signed) Date L /_ .... Stree -r'- t_ __— Subdivision_______(_—___ /Street ____________ – ______ -_____- - - - - ----------- - - - - -- Repairs No. of Stories __________.. Amount of Permit $_— c ( Signed) C_ I __________ _- Plumbing Inspector. The undersigned applicant for this building permit does he •eby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section ;966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar com ;Hance 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 post:d for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, } COUNTY OF DADE. 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, upor oath deposes and says that he is the of the above described construction, that he has carefully real 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. CLOSETS BATH TUBS SHOWERS LAVA TORIES SINKS SL[ P SIN CS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST �`.F ...) / r / /. .1' . ' CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOL 1R H EA - ER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST 1 / I CHECK MIAMI SHORES VILLAGE Permit No., €> Owner's Name and Address Registered Architect and /or Engineer Employing Plumber's Name ______>.„. Location and Legal Description Lot__ /-'__�____'______. PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed st Itement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in complian:e and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordina ices 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. No.---r - - -aZ Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floo s) New Building Remodeling Addition No Street Capacity Gals.___ Size Septic Tank_ Type of 7 ank Feet of Drain Tile_____ _____________— _______ ___ Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City-4.--Well — _____..__________.Size of Soakage Pit (Signed) Date L /_ .... Stree -r'- t_ __— Subdivision_______(_—___ /Street ____________ – ______ -_____- - - - - ----------- - - - - -- Repairs No. of Stories __________.. Amount of Permit $_— c ( Signed) C_ I __________ _- Plumbing Inspector. The undersigned applicant for this building permit does he •eby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section ;966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar com ;Hance 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 post:d for inspection on the site of the work such public notice or notices as are required by the Act. The under signed agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, } COUNTY OF DADE. 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, upor oath deposes and says that he is the of the above described construction, that he has carefully real 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. Size Septic Tank MIAMI S --1ORES VIL(AGE PLUMBING INSPECTION DEPARTM T APPLICATION F=OR PLUMBING - PERMIT Permit No..____ -- ------------------------ Amount of Permit $_�,., The undersigned applicant for this building permit does h:reby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar con pliance performed under this permit; and will post or cause to be pm red for required by the Act. The under signed agrees to employ onl r such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly appeared SS. My Commission Expires (Signed) (Signed) ^ Date - 'tJ Application islhereby made for the approval of the detailed s atement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in complia Ice and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordin. nces of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village :hall be complied with.�vhether he •ein specified or not. A copy of approved plans and specifications must be kept at building during progress of wor - r. ' `` 1 $ �P` �:..�. ' • . _.,�• a .. r Owner's Name and Address � ' -__ -_ No. Street____ Registered Architect and /or Engineer Employing Plumber's Name No Location and Legal Description Lot Block Subdivision_ Street and Number where work is to be performed- -No. a Street__________________ _______________________________ State work to be performed and purpose of building (By Flo, rs) _ New Building __ s Remodeling Street_____.,: Addition Repairs No. of Stories Type of ' "ank . Capacity Gals Feet of Drain Tile Dist. Feet of Tan c or Drain Field from Well Nature of Water Supply: City —Well. 1 1 Size of Soakage Pit Notary Public. State of Florida • a • 1 M Plumbing Inspector. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are / Master Plumber. authorized to administer oaths and take acknowledgments, personally to me well known, and who, being by me first duly sworn, upo T oath deposes and says that he is the of the above described construction, that he has carefully re, d the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made wher such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA TORT F' NKS St DP SI' 1K3 LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SO .AR HE) TER DEEP WELL SPRKLR. SYSTEM Y SWIM'G POOL CONTR. LIST CHECK Size Septic Tank MIAMI S --1ORES VIL(AGE PLUMBING INSPECTION DEPARTM T APPLICATION F=OR PLUMBING - PERMIT Permit No..____ -- ------------------------ Amount of Permit $_�,., The undersigned applicant for this building permit does h:reby ce under the Florida Workmen's Compensation Act, being Section 5966, plied with the provisions thereof, and will require similar con pliance performed under this permit; and will post or cause to be pm red for required by the Act. The under signed agrees to employ onl r such licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly appeared SS. My Commission Expires (Signed) (Signed) ^ Date - 'tJ Application islhereby made for the approval of the detailed s atement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in complia Ice and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordin. nces of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village :hall be complied with.�vhether he •ein specified or not. A copy of approved plans and specifications must be kept at building during progress of wor - r. ' `` 1 $ �P` �:..�. ' • . _.,�• a .. r Owner's Name and Address � ' -__ -_ No. Street____ Registered Architect and /or Engineer Employing Plumber's Name No Location and Legal Description Lot Block Subdivision_ Street and Number where work is to be performed- -No. a Street__________________ _______________________________ State work to be performed and purpose of building (By Flo, rs) _ New Building __ s Remodeling Street_____.,: Addition Repairs No. of Stories Type of ' "ank . Capacity Gals Feet of Drain Tile Dist. Feet of Tan c or Drain Field from Well Nature of Water Supply: City —Well. 1 1 Size of Soakage Pit Notary Public. State of Florida • a • 1 M Plumbing Inspector. rtify that he understands and accepts his obligations as an employer of labor Compiled General Laws of Florida Permanent Supplement, and has com- from all contractors or sub - contractors employed by him in the work to be inspection on the site of the work such public notice or notices as are sub - contractors, on work to be performed under this permit, as are / Master Plumber. authorized to administer oaths and take acknowledgments, personally to me well known, and who, being by me first duly sworn, upo T oath deposes and says that he is the of the above described construction, that he has carefully re, d the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made wher such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/31/2003 Applicant: ALEXANDER Owner: QUINTANA JOB ADDRESS: 366 NE 93 Contractor PRONTO PLUMBING INC Local Phone: 305 - 892 -2255 Parcel # 1132060136320 11 () s'. n Permit Status: Work: NEW SINK AND DISHWASHER PAY TO THE !« O RDE OF iH 11 2 78 511' APPROVED Permit Expiration: PRO`' p O• P MBING INC. 1213 NE 11TH PLACE NORTH MIAMI, FL 33161 7/30/2003 1:06 70 L L8 2 SI: 50 5064 5 L06t1■ Plumbing Permit Permit Number: PL2003 -36 QUINTANA ALEXANDER ST Contractor's Address: 12135 NE 11 PL Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 W1/2 LOT 2 -LOT 3 & 4 & E1/2 LOT 5 BLK 47 Construction Value: (i) 21-( $300.00 DATE tO O7 63- 1182/670 Total Receipts: Fee�u�e. Page 1 of 1 o c> Total Fees: $0:08 $0.00 2e- inspection cation herefor in strict compliance with all fications that may have been submitted to ; or if the plans are changed without ronsibility for a thorough knowledge of the :hat he assumes responsibility for work done 1s pertaining thereto and in strict conformity asponisibility for all work done by either Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVC) yO .JR.'VALIDAZ`EIS PERMIT I.ND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION a t limittd to: Motday tITrough Filth 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 SANI1AR' CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KETIVR�EE F DIRTANI»DBBRIS• 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BYEQUTAIreIEleTiOH VEHiCI:ES 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 70 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 Depatment (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 rzgulating 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 awarz, 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 mo:e 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. SignatL, �/ /Owner 1 7 (")Y ICI .0 0 1n t 0 Print Name Sworn to and subscribed before me this 2`1. day of o 2Q ra �. v Signature of Notary Public - State of Florida __= 1CIALi�OYARd SEAS SEAL: O��QV pUB�i AFlTNUR pr H S70s IE 2 c 11;v1ISSIoN NURABEFI! Ji' n ¢ DD00468 ( .0 :. v CO'�P70461 EXPIRES I ! tt 0� `.AAR.21, Personally know °! ° OR, Pr Identification Type of Identification Produced: • • . • • • • • • • • ••• • • • • • • • • • • • ... • • ...... • Y OF MIAMI-DADE STATE OFFI I9RIDA, COU Signature oftontractor / qualifier SEAL: PERMIT APPLICATION rt MI -DA Print Name Sworn to and subscribed before me this > day o oHry b eof orida Amid+^ `o' ti ,:aiP., ��yy O � 5004i9 Personally known -- Produced Identiion Type of Identification Produced: CONTRACTOR New Construction Name A 1 I 0 / /, [ J' ( !t &t71 ' t\ Name Address 3t� �9 NE Q 3 `L 11..A� 1 Gvh , I ts►- 3 -�� - o 1 3'g 1 R' License No. GFCo s�7 2 Business Telephone (3 05) 7 4 / . -- 3 Address f7 / Q p fit, F64- J 73/6 Telephone , 2 Z r ifi Relocation of Structure _._ Qualifier Namy - 1 Foundation Only PROPERTY OWNER New Construction Name A 1 I 0 / /, [ J' ( !t &t71 ' t\ Enclosure Address 3t� �9 NE Q 3 `L 11..A� 1 Gvh , I ts►- 3 -�� - o 1 3'g 1 R' Home Telephone C os) 7S 4 7 1 / — C, � 2 Business Telephone (3 05) 7 4 / . -- 3 $ 3 Fax Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior V Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Job Address: , 3 (2 (11 ,J e G 3 IAA 1 a►'" 1 Address Apt. City Folio Number I/ 3.1"0 6- 0 /3— (4'3 01 -° Description of Work Block Lot Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other e. ■ •• • • • • • •• •• • • • • • • • • • • • • • • .•• • • • • • • • • • • • • • • • • • • • .•• • • • • • ••• • •• • . • • • • • • • • • • • • • • .••. •.. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Square Feet Value of Work Flood Zone Master Permit No. B P - 40'3 -1 b • et;bsi I ary Permit No. � L Z (903 3 . INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit applica oe •vI ch m Est be gignedtbytthe property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate pro.ossiag of }tout applicauon. 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. APPLICATION Zoning Linear Feet - "--) Tax Assessed/Appraised Value •. • ••.• State Units Floors Bldg Value _r Base Floor Elev. . PERMIT APPLICATION 33 (3 Zip ENGINEER Name License No. Address Telephone Fax ELECTRICAL TYPP. QTV. TYPE ')TV 7l' "E Q'1'V. TVI'I Q"i'1'. Minimum Fee QTV'. Dryer • • • • Outlet, Appliance Outlet, Wall Service Repair Service, Temporary A/C Central 1 -3 Ton Fan A/C Central 4 -7 Ton A/C Wall/Win. Tons Fire Pump Dryer Vents, Number of Outlet, Switch Paint Booth Signs Ventilation, Cost A/C Central 8 -15 Ton Air Handler, Tons Fixture - Fluorescent Ductwork, Cost of Oven Piping, Flammable Liquid Space Heater (kw) Periodic Inspections A/C Central 16-20 Ton Barbecue Fixture Light Fire Sprinkler System Parking Lot Lights Process/Pressure Piping Spas/Hot Tubs Supply, AC Well A/C Central 20+ Ton Bath Fan - Vented, # Flood Lights Fireplaces, Number of Plugmold/Strip Pressure Vessel Subfeeds, No. of Amps Temporary Toilet A/C Window Catch Basin FPL - Load Central Gas - Propane Posts Pump, Re- circulate Swim Pool, Commercial Temporary Water Closet Air Conditioners Clothes Washer Garbage Disposal Gas Piping Range/Range Top Pump, Replace - Pool Swim Pool, Residential Urinal Chiller Dental Chair Generators, etc. Grease Trap Receptacles Pump, Sprinkler Switchboards Utility - Sewer Clear Violations Discharge Well Heat Recovery Ice Maker Refrigerator, Comm. (p/PH) Pump, Sump Temp Serv., Construction Utility - Water Compactor Dishwasher Low -volt, Burglar Indirect Wastes Refrigerator, Domestic Relay Repair Temp for Test - 30 days Vacuum Pump Deep Freezer Disposal Low -volt, Fire Interceptor Renew - Temp Service Roof Inlet Water Closet Demolition Domestic Well Low -volt, Intercom/Telep'i. Laundry Tray Repair Circuits Septic Connection Water Heater Dishwasher Drainfield, 4" Tile/Res. Low -volt, Television Lavatory Service, Number of Amps Septic Tank Water Heater New NIECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. '1'1'1'1: Generator QTV'. TYPE Refrigeration, Tons QTY. A/C Central, Tons 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 Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPP. Soakage Pit QTV. 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 f Pump, Sump Utility - Water Dishwasher 1 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 • • • • • • • • ... • • • • • • • • • • • • • • •• • • • • ••• • • • • ••• •• • • • • • • • • - PERMIT APPLICATION INSTRUCTIONS: Please indicate the tyke of I,vctk :bding Deffo n d and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY 1 DATE Zoning Electrical Mechanical Plumbing ® All . . % -0 Fire ivy " 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) PERMIT 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 Or OWNERSHIP • (Attach) •• ••• •• • • • • . . . ❑ HRS / DERIVAPPRI Vq}r . (Septic / Sear) • • • • • • • • • • ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) • •. .• • • • • • • • • • • • • • • • • ... • • • • • • • • • • • .. • • • • .. . • • ... (s . f t. x/1000 x (¢.005 /sq.ft.) (¢.01 /sq.ft.) • PERMIT APPLICATION L1 CONDO ASSOCIATION APPROVAL (Attach) • • •. • . • I 1 PR APPROVAL (Restaurants) • ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: 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