STRUCTURAL BEAMDate •
Legal Description
K Owner/Lessee/Tenet
A er's Address
Contracting Co.
Qualifier
State # Municipal #
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
EFO CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one):
DESCRIPTION:
Square Ft. Es imated Cost (value)
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 ANY 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 addendu
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that s
for all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be one in pomp
regulating construction and zoning. Furthermore, 1 authorize the above named contra • se work st ed.
Signature of owner and/or Condo Presid
cn
c
Notary gs;to Own
My Cori mission Expires
U
--.a
-
® �
FEES: PTKJ.MIT
4-S
APPROVED:
Zoning
L.J
Mechanical
10050 N.E. 2n
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job ASdres
��� / M. ,\ Historically Designated:
d ✓ V ,p c, LO , Master Permit #
3'� (V � � Ph
19r-P, 44,,E aviddrt)(17
or Condo President
Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 305- 756 -8972
1 v�..�
-S Tax Folio
UILDIN
7 0 (014 ree
-cm° c )c_) tbAckk.,,
RADON C.C.F
Building
ELECTRICAL
Date
SS# Phone
Competency #
Signat
Address
PLUMBING
Date Notary as to Con
NOTARY
Plumbing
1
Yes
My Commission Expires
ed
a
[ [ C_(I V [
MAY
Ins. Co.
r Owner Builder
MECHANICAL
(if applicable). I certify that
rate permits are required
e with all applicable laws
Structural Engineer WI
ROOFING
Date
Date
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305 - 795 -2204
Building Inspection Request
Date
Type Insp' c
Permit No. - y 0 3 55 P
N
Address 3-5 0 nri \
Company : • , ; A i
Phon 30s— 0 ( c - e A--3
For Inspector: 1' / 2 / __Same & Date
Approved
Correction
Re- Insp'n Fee
4.
V)