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801 NE 92 St (9)f/,s S?4 t‘,2,27 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 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. Amount of Permit 8 My Commission Expires Notary Public, State of Florida We-- Owners Name and Address No Street ._ A Registered Architect and /or Engineer /f - fx'ee- /c P l s N e D — � -d en%c N a. L`� .al.: 4 ° ' . i .1 1° ��pl� ,g �m .... , .f / /L,o c� ati on rP and O Ll6gal Desrr /O ption Lot 1.12Z ° LL Block / _ Subdiv k-- N Street and Number where work is to be performed-No Street.._.. State work to be performed and purpose of building (By Floors ) -.. 'd -.1� -7_V4.__ 10We _ New Building..___ _----- • - -• -- Remodeling —___ Addition... - - -- - .- _ -.... Repairs -1 epal» e '- No. of Stories _T of T..,>< 3/te 2 c 2 . _.- ...- ._...._ -. Sire Septic Tank._. -Type - • -CaPacity Gals._•-- .._... -- - _ - - -•- Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well ;' f.. Nature of Water Supply: City-Well. Size of Soakage Pit 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 5908, Compiled General Laws of Florida Permanent Supplement, and II„r com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worle 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 perfonr�ed under this perinit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, ss. 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 swan, upon oath deposes and says that he is the - .__.._ .. _ ...... _ _ ... —. of the above described construction, that be has carefully read the foregoing application, and that be did dips the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of 81.00 will be made whoa sear ssiaspeotfea Y snad••aslassery by improper notice for inspection, at faulty materials and /ar workmanship. CLes Ta BATH Tulle SHOW[RL LAVA- TORIEL aINKL SLOP $INK• LAUNDRY Tuns URINALS CATCH •ALIN FLOOR DRAIN DRINKI NO FOUNT •NS TOTAL FIXTURES CONTW. LILT CHICK —� — SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAOL PIT G TRAP SOLAR NEATER DRIP WELL e . a SWIM'O POOL CONTR. LILT . CHICK f/,s S?4 t‘,2,27 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Permit No 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. Amount of Permit 8 My Commission Expires Notary Public, State of Florida We-- Owners Name and Address No Street ._ A Registered Architect and /or Engineer /f - fx'ee- /c P l s N e D — � -d en%c N a. L`� .al.: 4 ° ' . i .1 1° ��pl� ,g �m .... , .f / /L,o c� ati on rP and O Ll6gal Desrr /O ption Lot 1.12Z ° LL Block / _ Subdiv k-- N Street and Number where work is to be performed-No Street.._.. State work to be performed and purpose of building (By Floors ) -.. 'd -.1� -7_V4.__ 10We _ New Building..___ _----- • - -• -- Remodeling —___ Addition... - - -- - .- _ -.... Repairs -1 epal» e '- No. of Stories _T of T..,>< 3/te 2 c 2 . _.- ...- ._...._ -. Sire Septic Tank._. -Type - • -CaPacity Gals._•-- .._... -- - _ - - -•- Feet of Drain Tile Dist- Feet of Tank or Drain Field from Well ;' f.. Nature of Water Supply: City-Well. Size of Soakage Pit 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 5908, Compiled General Laws of Florida Permanent Supplement, and II„r com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the worle 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 perfonr�ed under this perinit, as are licensed by Miami Shores Village. Master Plumber. STATE OF FLORIDA, ss. 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 swan, upon oath deposes and says that he is the - .__.._ .. _ ...... _ _ ... —. of the above described construction, that be has carefully read the foregoing application, and that be did dips the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of 81.00 will be made whoa sear ssiaspeotfea Y snad••aslassery by improper notice for inspection, at faulty materials and /ar workmanship. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant C-0 c K Permit Nu amber /02-,4 A0(at rs 1 O / /J, 6. o`2 S p- PART II - SYSTEM INSTALLATION INSPECTION AND FINAL fNSTALLATI N APPROVAL Installer ■9- 1(-d S 9 7 c., Tank Manufacturer N/A Yes M No gallons gallons Proper tank legend: Yes N1i9 No Tank material C-ah c./ -e Tank level: ----- Tanks watertight: Yes No Tank size: gallons Proper tank outlet device: Yes,/ .9 No Manhole or marker to grade: Yes _ No Drainfield Trench Absorption Bed Length Width Length Width Length 2_ feet x 8.V feet (Lat .r- feet feet feet feet Length feetx feet = ---ft2 feet feet rl feet feet Proper No. drainlines: Yes Li / No feet feet feet feet Proper pipe separation: Yes ' No Total = ft Total = ft Distribution box level: Yes No* Systems located as permitted: Yes No Systems including plumbing stub -outs installed at proper elevation: Yes No ' Average depth to drainpipe invert from finished grade: inches Maximum depth Inches Average depth of drainfield gravel: Proper gravel size: Yes IV No Gravel is suitable quality: Yes I/ No Backfill or fill material as required: (Quality) Yes v No (Quantity) Yes ✓ No Other findings: 9, .376 c g. p Inspected by / - /-6 Elit-t HRS—H Form 4016, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4016-0) inches Minimum depth of gravel inches G Date 6// . PART III - FIN L TION APPROVAL Date s r 0- 0 Approved by: i C4041' COUNTY PUBLIC HEALTH UNIT AN APPROVED INSTALLATI t DOE NOT GUARANTEE PERFORMANCE Note: Completed copies of this form will b pro ded to 'e applicant, installer and the building department. Page 2 of 2 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT A/72_ _-_574/-3 G 2 7Z Permit No 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. Owner's Name and Address V' C O 0 C r?) �y Registered Architect and /or Engineer Employing Plumber's Name � 5 . S/S'P ,/ . fi r/ u No. . Location and Legal Description Lot. Bloeir Subdivision Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)__. New Building._ _______ _ Remodeling _ Addition. CLosETs BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuns URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS CONTR. LIST CHECK CONTR. LIST CHECK SEPTIC TANK SEWER CONN. Size Septic Tank__ Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. es. DRAIN FIELD Amount of Permit $ SOAKAGE PIT 0 TRAP SOLAR NEATER Type of Tank DEEP WELL BPRKLR. SYSTEM 1 )ist. Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well. Size of Soakage Pit (Signed) (Signed)_ Sw IM' POOL Street Repairs No. of Stories. .. Capacity Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obit ons as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Pennan u Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or subcontractors em . dyed 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 . a formed under permit, as are licensed by Miami Shores Village. er t Pe )25 1: • Master Plumber. TOTAL FIXTURES 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 NOTE: A re- inspection fee of $1.00 will be made when such eednrpecton L made'neoetsary by improper notice for inspection, or faulty materials and /or workmanship. W1r .slit No. . ._ E _ Date E f jj - f f 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. Owner's Name and Address • Registered Architect and /or Engineer_ ______ - Employing Plumber's Name tee �� � '7� --- /?�- i�+'�- 1 ..�_x.py�_ _ . � -�- N _____ - -��� Street_. Location and Legal Description Lot ___..__.____._..._.___._._.____ _ _— Block Subdivision 7 Street and Number where work is to be performed —No e Q / Street z State work to be performed and purpose of building (By Floors) _ = ____ 44i &_,E 1 k &' d 2- -5^ 1 04- e Ci< 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 .________._.__- _.-- __.- _. -__— ______Size of Soakage Pit Amount of Permit $__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT t rL__ • - s Tre) ___ -- No. 1 Street•_S_l ( 2 - 1S/ Repairs No. of Stories . . ..................... . Capacity Gals (Signed)- :- = -``.� The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perinan plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e performed under this permit; and will post or cause to be posted' for inspection on • site of the wo required by the Act. The undersigned agrees to employ only such sub - contractors, o work to llcensed by Miami Shores Village. (Signed)__ ✓ eA 0/ AFTCA 4 r'�l Plumbing Inspector. ns as an employer of labor Supplement, and has com- yed by him in the work to be blic notice or notices as are ed under this permit, as are ' Master Plumber. STATE OF FLORIDA, t ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to admini 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 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. CLC'$8T- BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY Tuas U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NE TOTAL FIXTURES CoNTF4. ...I ''e (:NEC% SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHECK W1r .slit No. . ._ E _ Date E f jj - f f 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. Owner's Name and Address • Registered Architect and /or Engineer_ ______ - Employing Plumber's Name tee �� � '7� --- /?�- i�+'�- 1 ..�_x.py�_ _ . � -�- N _____ - -��� Street_. Location and Legal Description Lot ___..__.____._..._.___._._.____ _ _— Block Subdivision 7 Street and Number where work is to be performed —No e Q / Street z State work to be performed and purpose of building (By Floors) _ = ____ 44i &_,E 1 k &' d 2- -5^ 1 04- e Ci< 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 .________._.__- _.-- __.- _. -__— ______Size of Soakage Pit Amount of Permit $__ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT t rL__ • - s Tre) ___ -- No. 1 Street•_S_l ( 2 - 1S/ Repairs No. of Stories . . ..................... . Capacity Gals (Signed)- :- = -``.� The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblig under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perinan plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors e performed under this permit; and will post or cause to be posted' for inspection on • site of the wo required by the Act. The undersigned agrees to employ only such sub - contractors, o work to llcensed by Miami Shores Village. (Signed)__ ✓ eA 0/ AFTCA 4 r'�l Plumbing Inspector. ns as an employer of labor Supplement, and has com- yed by him in the work to be blic notice or notices as are ed under this permit, as are ' Master Plumber. STATE OF FLORIDA, t ss. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to admini 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 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. I DA E Amt. of Permit 6 /c' 194S i' Contractor's License No . tall the equipment or device described in the appli- the work will be performed in compliance with any - municipal authorities. This Permit may be revoked it authorization. A further condition upon which this lity for a thorough knowledge of the ordinances and ' -men or .pecifications and th he : ssumes respon- k JR er in compliance with 41 es altd ag }a_ n =ed to the proper authoritt�i•�rzzs of M : mi Shores Village. A mployee. i No. Date Application ' 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, ein specified or not. A copy of approved plans and specifications must be kept at Owner's Name and Address Li: /)- " , No . k / Stred if P ' uring progress of building „.../ Registered Architect and /or E Employing Plumber's Nan No._ ___ Stree : ____ - -- - ^- --- - -- - Location and Legal Description Lot _1 `- `3 ” Block Subdivisi 0,- + L�j Ale Street and Number where work State work to be perforred and purpose of building (By Floors) New Building 1 Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile s t yDist. Feet of Tank or Drain Field from Well Size of Soakage Pit Nature of Water Supply: City —Well Amount of Permit $ is to be performed —No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT � �. -- - = 1 - -- = - P -- Street ( 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 Section 5966, 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 - contracto s 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 wort' .uch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, o I wo to be • erformed under this permit, as are licensed by Miami Shores Village. ( Signed u/ 0 s Cr`L My Commission Expires Notary Public, State of Florida Master Plumber. 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. 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. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and, take acknowledgments, personally appeared CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINK NG� FOUNT' NS TOTAL FIXTURES CONTR. LIST 1 t CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST / CHECK i No. Date Application ' 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, ein specified or not. A copy of approved plans and specifications must be kept at Owner's Name and Address Li: /)- " , No . k / Stred if P ' uring progress of building „.../ Registered Architect and /or E Employing Plumber's Nan No._ ___ Stree : ____ - -- - ^- --- - -- - Location and Legal Description Lot _1 `- `3 ” Block Subdivisi 0,- + L�j Ale Street and Number where work State work to be perforred and purpose of building (By Floors) New Building 1 Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile s t yDist. Feet of Tank or Drain Field from Well Size of Soakage Pit Nature of Water Supply: City —Well Amount of Permit $ is to be performed —No MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT � �. -- - = 1 - -- = - P -- Street ( 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 Section 5966, 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 - contracto s 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 wort' .uch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, o I wo to be • erformed under this permit, as are licensed by Miami Shores Village. ( Signed u/ 0 s Cr`L My Commission Expires Notary Public, State of Florida Master Plumber. 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. 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. STATE OF FLORIDA, COUNTY OF DADE. j Before me, the undersigned authority, a notary public, duly authorized to administer oaths and, take acknowledgments, personally appeared BUILDING ELECTRICAL PLUMBING Owner of Building 1 Architect Contractor .' or Builder MIAMI SHORES VILLAGE, FLORIDA DATE ' PERMIT N? 7307 Contractor's License No. Work to be performed under this Permit Legal Lot Bl. Subdi Description vision Address of /f . '.� Value of I Amt. of ' ` Project Permit / 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 appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 condit'•n upon which this permit is granted is the understanding that the contractor or builder named above assumes the r p sibility for a thorough knowledge e ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawyQgs orie statements or ycifications a e assumes respon- sibility for work done by his agents, servants or employees. / ,.� Si ed. f ! t i , !- f.,,.- .-- •-.-BY INSPECTOR �• - tion of the s e t me of this • it I agree to perform the work covered hereunder in compliance with all ordinances and regulations p r, . -reto and in s ty with ans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ,�: g this it I .s •onsibilit - ` a work done by either myself, my agent, servant or employee. CONTRACTOR OR BUILD , BY AUTHORITY 194 MIAMI SHORES VILLAGE, FLORIDA BUILDING DATE 194 ELECTRICAL PERMIT N° 7366 Contractor's. License No. PLUMBING V ip . i 1 --4 Work to be performedNunder this Permit / , / , / Owner of Building Architect Contractor /). or Builder - 11> £ Legal Lot Description - A / consideration of the iss Subdi- vision Address of Value of Project Building ., This permit is granted to the contractor builder named abo to construct the building or to install the equipment or device described in the appli- cation 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 i statements or specifications an at 1j, assumes respon- / sibility for work done by his agents, servants or employees. ) i _ . . Signed: I ,...' , a/ .0 By/ r INSPE OR / o ne of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations perta.n s thereto an in strict with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. \_ In a g this pe it I ass for all work done by either myself, my agent, servant or employee. BY AUTHORITY Size Septic Tank Feet of Drain Ti Owner's Name and Address Street and Number where work is to be performed —No Nature of Water Supply: y Amount of Permit MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) Permit No._�_�i" Dater r t _ �` 1 �l - 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. .I —__ _' No Street Registered Architect and /or Engineer Employing Plumber's Name_ __=_ —___ , , _ _______ `.;�� A /rT. -,. No Street Location and Legal Description Lot 'Block Subdivision . -- Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Type of Tank Capacity Gals._ le Dist. Feet of Tank or Drain Field from Well Su 1 Cit —Well. Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio . as an em under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by h performed under this permit; and will post or cause to be posted for inspection on the site of the work such public required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. J My Commission Expires Notary Public, State of Florida ss. / er" / �f ce or 7 ' this permit, - i (Signed _ Inspector. oyer of labor and has corn- the work to be notices as are as are 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. 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 SLOP SINKS LAUNDRY TUBS INALS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST — CHECK 11i SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER • V ,raRBP WELL SPRKLR. SYSTEM / SW IM'G P L CONTR. LIST / %)) .t' / /. [l f .. , r'�iL LJ -'� p CHECK Size Septic Tank Feet of Drain Ti Owner's Name and Address Street and Number where work is to be performed —No Nature of Water Supply: y Amount of Permit MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) Permit No._�_�i" Dater r t _ �` 1 �l - 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. .I —__ _' No Street Registered Architect and /or Engineer Employing Plumber's Name_ __=_ —___ , , _ _______ `.;�� A /rT. -,. No Street Location and Legal Description Lot 'Block Subdivision . -- Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Type of Tank Capacity Gals._ le Dist. Feet of Tank or Drain Field from Well Su 1 Cit —Well. Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatio . as an em under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by h performed under this permit; and will post or cause to be posted for inspection on the site of the work such public required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. J My Commission Expires Notary Public, State of Florida ss. / er" / �f ce or 7 ' this permit, - i (Signed _ Inspector. oyer of labor and has corn- the work to be notices as are as are 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. 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. Amount of Permit $ Permit No /- 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. Owner's Name and Address__ T _'_ /r Registered Architect and /or En eer__, Employing Plumbei s Nam ? �- - A' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT — No. - -�- - -- ---- ---- ._____ Stree No.____ U Location and Legal Description Lot -J' _ _._..________.__ �_ Block Subdivision Street and Number where work is to be performed —No 1 ;' 4/ Street State work to be performer and purpose of building (By Floors) Lt wi_: _L.1_,:_: 4 ___- ' , .1,4 "/"/ /°' '''7' - / /, n l New Building Remodeling Addition- -- _ --___ Repairs 4. --.- --- -__.__- s No. of Stories. Size Septic Tank_ ------ _- _--- .-- •------------- - -_ - -- Type of Tank Capacity Gals Feet of Drain Tile_____- { `----- -Digt. Feet of Tank or Drain Field from Well • Nature of Water Supply: City —Well . Size of Soakage Pit (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 Section 5966, 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. (Signed )- Master Plumber. STATE OF FLORIDA, t ae. 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 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. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS LIC;,.V ., - 4 1 r - )),. r.. TOTAL FIXTURES CONTR. LIST CHICK — / C/ 6 / - - -- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWI POOL CONTR. Liar —!— CHECK j , I-) Amount of Permit $ Permit No /- 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. Owner's Name and Address__ T _'_ /r Registered Architect and /or En eer__, Employing Plumbei s Nam ? �- - A' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT — No. - -�- - -- ---- ---- ._____ Stree No.____ U Location and Legal Description Lot -J' _ _._..________.__ �_ Block Subdivision Street and Number where work is to be performed —No 1 ;' 4/ Street State work to be performer and purpose of building (By Floors) Lt wi_: _L.1_,:_: 4 ___- ' , .1,4 "/"/ /°' '''7' - / /, n l New Building Remodeling Addition- -- _ --___ Repairs 4. --.- --- -__.__- s No. of Stories. Size Septic Tank_ ------ _- _--- .-- •------------- - -_ - -- Type of Tank Capacity Gals Feet of Drain Tile_____- { `----- -Digt. Feet of Tank or Drain Field from Well • Nature of Water Supply: City —Well . Size of Soakage Pit (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 Section 5966, 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. (Signed )- Master Plumber. STATE OF FLORIDA, t ae. 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 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. BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description PERMIT N? 8984 Work to be performed under this Permit +.. Signed In consideration of the issuance to me of this permit I agree to perform pertaining thereto and in strict conformity with the plane, drawings, In accepting this permit I assume responsibility for an work done by either MIAMI SHORES VILLAGE, FLORIDA DA 7 i. Address of Building This permit is granted to the contractor or builder named above to construct the building or cation herefor in strict compliance with all ordinances pertaining thereto and with dbe understanding plans, drawings, statements or specifications that may ve been submitted to and approved by the at any time if the work is nor done in compliance with such ordinances or if. plant are changed a permit is granted is the understanding that the contractor or builder named above eumes the regulations pertaining to the work covered hereby whether shown on the or in sibility for work done by his agents, servants or employees. Contractor's License No. t the w m or *rim tb be peeks* munldpal authorities. Tris authorization. A for a is or daTralleaVE Permit No ,T2 Nature of Water Supply: City —Well Amount of Permit $__ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. Owner's Name and Address_21 -_)/_ . No Street Registered Architect and /or Engin er, Employing Plumber's Name _____ -_ ___ Location and Legal Descriptio of Bloc Subdivision _____________ Street and Number where work is to be performed— No.__a__l1__1 ___ Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No Size Septic Tank Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit ( Signed) ( Signed ) _' Capacity Gals Street l ' Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he Imo: erstands and accepts his obligati s 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 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. No. of Stories Master 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 NOTE: d 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 SLOP SINKS LAUNDRY TU ®5 URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. LIST CHECK Permit No ,T2 Nature of Water Supply: City —Well Amount of Permit $__ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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. Owner's Name and Address_21 -_)/_ . No Street Registered Architect and /or Engin er, Employing Plumber's Name _____ -_ ___ Location and Legal Descriptio of Bloc Subdivision _____________ Street and Number where work is to be performed— No.__a__l1__1 ___ Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No Size Septic Tank Type of Tank_ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Size of Soakage Pit ( Signed) ( Signed ) _' Capacity Gals Street l ' Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he Imo: erstands and accepts his obligati s 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 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. No. of Stories Master 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 NOTE: d 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. Registered Architect and /or Engineer______-- -.—___ Employing Plumbers Name_ No._2,414 Street_ —o Location and Legal Description Lot_ Block Subdivision Street and Number where work is to be performed —No .l L Street Permit No Cl / 1 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. Owner's Name and Address_ Size Septic Tank- - - - - -- Feet of Drain Tile_ Nature of Water Supply: City—Well. Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. No._ State work to be performed and purpose of building (By F loors)____________________ - - - -_ New Building ___ Remodeling____ Addition__ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT PPS, CATION FOR PLUMBING PERMIT - -� (Signed)_ ( y , ( Signed )_ --- . _ Street. ) I , fl @. Repairs No. of Stories_ _ _ _ __ _.____Type of Tank___ —Dist. Feet of Tank or Drain Field from Well. __Size of Soakage Pit Capacity Gals. P1uraing1ti pector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi bligations 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 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. aster 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. 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 notic. for ins, -► or faulty materials and/or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINAL S CATCH k BASIN ' FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK - SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL -Y � SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / ......12Z_ CHECK Registered Architect and /or Engineer______-- -.—___ Employing Plumbers Name_ No._2,414 Street_ —o Location and Legal Description Lot_ Block Subdivision Street and Number where work is to be performed —No .l L Street Permit No Cl / 1 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. Owner's Name and Address_ Size Septic Tank- - - - - -- Feet of Drain Tile_ Nature of Water Supply: City—Well. Amount of Permit $_ STATE OF FLORIDA, COUNTY OF DADE. No._ State work to be performed and purpose of building (By F loors)____________________ - - - -_ New Building ___ Remodeling____ Addition__ My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT PPS, CATION FOR PLUMBING PERMIT - -� (Signed)_ ( y , ( Signed )_ --- . _ Street. ) I , fl @. Repairs No. of Stories_ _ _ _ __ _.____Type of Tank___ —Dist. Feet of Tank or Drain Field from Well. __Size of Soakage Pit Capacity Gals. P1uraing1ti pector. The undersigned applicant for this building permit does hereby certify that he understands and accepts hi bligations 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 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. aster 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. 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 notic. for ins, -► or faulty materials and/or workmanship. lte C } Job Address 1 t 4 T 2 - otary as to Owner and /or Iy Commission Expires: . * * PPROVED: Y i Riv1fl ArFFLICA 1 toil 11 OR MIAMI SHORES VILLAGE AfVMANDO G. CUSAS tr�N MY COMMISSION # CC 449735 EXPIRES: April 7 I999 * ft/ ti !kaatad Thn Nott? iif ic4WTIGBIB EES: PERMIT q RADON * C.C.P. Fire Zoning Buildin Mechanical Plumbin Signature Date: Tax Folio =gal Description ":740 / Lessee / Tenant N,/ e "A/ / 1'i1 ,4 . Master Permit IE L/ 2-3 viler 's Address f®/ /1/F" 9,Z ^� ontracting Co. _ 7 STS Mf Address 4' W , f x ila rtalifier C Arle,5 4 • rldhlassit Phone 4 0 i 3 Phone 7 6 - eell tate fP oe.227 Municipal 0 Competency 0 Ins.Co. rchitect /Engineer Address -)nding Company Address '>rtgagor Address 'rmit Type(circle one): BUILDING ELECTRICAL PLUMBING CHANIC ROOFING PAVING FENCE SIGN ORK DESCRIPTION C L( 1 ��� 1 �� tie ivare Pt. Estimated Cost(value) 3 70 O '.RNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO O MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND O OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OTICE OF COMMENCEMENT). pplication is hereby made to obtain a permit to do work and installation as indicated above, and n the attached addendum (if applicable). I certify that all work will be performed to meet the tandards of all laws regulating construction in this jurisdiction. I understand that separate 9.rmits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOPING and MECHANICAL WORK. WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will e done in compliance with all applicable laws regulating con ruc =nd z•ning. Furthermore, I uthorize he abovep►aw d contractor to do the work stat -• 1 .r • Flo .-- ,'a ignatui'e of owner/ and /or Condo President ate: 0 tor or Owner-Builder Not «atw"a% ' W__ . ASR e Builder My ' 1 tio W. „ Notary Public, State of Florida 1, $ e 4' Commission No. CC 427770 F aso MyCommisaionExPtr 12/20!9$ * it lelOW ullt K ll� W&W WW el NOTARY TOTAL DUE _55 / 5 6 * ** Other Electrical Engineering - Customer Name �f ,• . I /l - - --°, f , (-, /; ,6 II l 'v.z. r."( Home PH , 1 '7 1 11" : f / - / Work PH Service Address E!, d A Q � r, ... l City /'a A . I TV/ l'B� i St. .P- ( Zip 1 ) 16 Buyer Name/ Mailing Address C City St. . Zip - Federal Taxpayer ID# Acct. # a(,p] / ' 7I 7 Tax Dis trict ❑ City �7 County Date Required Contact Name ` =J�% .0 Phone No. ? i : <' j f •. O Date Scheduled , :?/! 1 ) Salesperson fr��/ � GA9$ERVICE ❑ LPG -Bulk Natural ❑ LPG -MTR ❑ Other ❑ LPG -Cyl SERVICE TYPE ❑ Restart ❑ Retention ❑ New On ❑ Reactivate ❑ RetJidd ❑ New Off 10,0‘d ed Load O Other Revenue Rate Class 10 SIC Code , AFE# W 't J J N a W ❑ dirt ❑ brick ❑ paved ❑ width ❑ trees ❑ fences ❑ walks ❑ bushes ❑ sprinkler ❑ bore: ❑ new ❑ existing ❑ block ❑ frame ❑ stucco ❑ siding ❑ other ' ❑ ROUGH IN NEEDED MAP ❑ LOCATION 1 asphalt ❑ flat ❑tile - - ❑ regular ❑ tin ❑ 12 pitch ❑rock ❑ other attic Y N under Y N slab Y N size length difficulty: ❑ simple ❑ moderate ❑ difficult ❑ Existing ❑ under stubouts ❑ New ❑ attic outlets length 0 inside ❑ W/H SHED size ❑outside ❑ W/H STAND relief ❑ in wall ❑ COMB VENT pan: 0 metal ❑ w/h ❑ THERMOSTAT WRING ❑ plastic • ❑ range ❑heater 0 other Distance from street: Existing: size ❑ 100# cyl New: ❑ w/h ❑ 120 tank ❑ range ❑ 250 tank size ❑ heater ❑ other to w/h ❑other ❑ DRAIN FIELD ❑ SEPTIC TANK to other ❑ # of Risers appls. ❑ # of Meters ❑ Meter Size 0 ABOVE GROUND total ❑ BELOW GROUND Z EAT (G) CFH Pressure at EQPT µ �3°' ow o �� S F t- . ( 4 Id _ , — r, F /� AMOUNT TO COLLECT $ Customer Approval: Present Load Additional Load K.