PLUMBINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date /ifr Address ( O g- k)e 9 4- S 4-, Tax Folio 1 1 3 - J.0500 - 70 ,Y0
Legal Description Historically Designated: Yes No
Owner/Lessee / Tena 7 L' 011 Sk r' 0 )2- OS N2g__ r ` Master Permit l '7 5 5 q il g0 6 9
Owner's Address Phone
Contracting Co. 422 va .S / f/ S Address 6 /q7 - 0 S Gf/ 2 ,5
Qualifier l� (2 06 0 -1 /O t/O SS# Phone `/ /y, 7/
State # l Municipal # Competency # Ins. Co.
Architect/Engineer Address b( (- n� 3 � 6)--1 h 5- LI 1 L I C I
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRIC ' LU BING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 11" r (Ale
Square Ft. Estimated Cost (value) (6
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Notary as t. i' : d/or Condo President
My Commission Expires: -. 3(D, z cx3'3
FEES: PE
4
e P4 4, SUZETTE A LAMACHE
MY COMMISSION # CC 875579
O F EXPIRES: Sep 30, 2003
1.800.3-NOT a, - Notary Service 8 Bonding Co.
•
11
RADON
APPROVED:
Zoning Building
chanical Plumbing
s
• E NOV R-1DA
N Y PUBLI STATE OF-Fb6
COMMISSION NO. CC94362 8,2004
M COMMISSION EXP.
C.C.F. NOTARY—. r)-- : • s
Signature of Contractor or Owner- Builder
Notary as to Contractor or Owner -B
My Commission Expires:
Electrical
/ z 96
der
.i
TOTAL DUE ,
Date
Date
Structural Engineer
ITEM
BATH TUB
BIDET
DISHWASHER
DISPOSAL
DRINKING FOUNTAIN
FLOOR DRAIN
GREASE TRAP
INTERCEPTOR
LAVATORY
LAUNDRY TRAY
CLOTHES WASHER
SHOWER
SINK, POT /3 COMP.
SINK, RESIDENCE
SINK, SLOP
TEMPORARY WATER CLOSET
URINAL
WATER CLOSET
INDIRECT WASTES
WATER SUPPLY TO:
A/C UNIT
FIRE SPRINKLER
HEATER -NEW INST.
HEATER- REPLACE ��
LAWN SPRINKLER -WELL
S L Zc�n2S
WATER SERVICE
EWER CONNECTIONS
UTILITY -SEWER
TILITY -WATER
EPTIC TANK
ELAY
RAINFIELO, 4' TILE/RES.
UhP 8 ABANDON SEPTIC TANK
JAKAGE PIT CU. FT.
UCH BASIN
ISCHARGE WELL
)MESTIC WELL
1EA DRAIN
)OF INLET
)LAR WATER HEATER
RE STANDPIPE
OL PIPING
WN SPRINKLER SYSTEM
S RANGE
TER SET (GAS)
S PIPING
° ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL
UNIT I FEE
ITEM
SWITCH OUTLETS
LIGHT OUTLETS
RECEPTACLES
SERVICE TEMPORARY
SERVICE SIZE IN AMPS
SERVICE REPAIR/METER CHANGE
APPLIANCE OUTLETS
RANGE TOP
OVEN
WATER HEATER
MOTORS 0- 1 HP
MOTORS OVER 1- 3 HP
MOTORS OVER 3- 5 If
MOTORS OVER 5- 8 IIP
MOTORS OVER 8- 10 HP
MOTCRS OVER 10- 25 HP
MOTORS OVER 25-100 HP
MOTORS OVER 100 HP
A/C WINDOW
AIR CONDITIONERS
STRIP HEATER
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
1
SPECIAL PURPOSE
OUTLETS COMMERCIAL
SIGN TUBES
SIGN TRANSFORMERS
SIGN TIME CLOCK
I FIXTURES
ANTENNA
TELEVISION OUTLETS
VIOLATION
REINSPECTION
UNIT
FEE ITEM
SPACE HEATERS
CENTRAL HEATING
A/C (WIND)
A/C (CENTRAL)
DUCTWORK
REFRIGERATION
UNIT
PROCESS AND PRESS PIPING
UNDERGROUND TANKS
ABOVE GROUND TANKS
U.F. PRESSURE VESSELS
STEAM BOILERS
HOT WATER BOILERS
MECHANICAL VENTILATION
TRANSPORTING ASSEMBLIES
ELEVATORS/ESCALATORS
FIRE SPRINKLER SYSTEMS
COOLING TOWERS
VIOLATION
REINSPECTION
FEE
PERMIT Q AP ^ PLICATII � O � N FOR MIAMI SHORES VILLAGE
Date i - 3 Job Address l O IOC N L � / 7 S r Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 1 Z ( Master Permit # / tO }
Phone C %'Y ��
Contracting Co. G) 1 7 S C u N f2 C J O R'S Address � �SW lOV W � /"� ✓���
Qualifier DAL) L L fJ a . IY` SS# �� _ . - phone (O �v �✓ / 7/ •.
Own er's Address l 0 9 A V 5 1 7 s
State #L A o6 (I6 S Municipal # Competency # Ins. Co. a 60/
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRIC PLUMBING CHANICAL ROOFING PAVING FENCE SIGN
WORK DES RIPTION Set 1 L ! rAlV /` RS A PAN ` i 9N1. 4 0 /JV ,
yc. (
Square Ft.
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 (W YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a pennit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
APPROVED:
Zoning
Mechanical
Plumbing
FEES: PERMIT RADON C.C.F. 4 '0 NOTARY ^17 v BOND
oa
Estimated Cost (value)
Building Electrical
•
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«ii NOTARY SEAL
y Commission % • tres: UD TWYFORD
NOTARY PUBLIC STATE 07 FLO:UDA
COMMISSION NO. CC7 4(.353
MY COMMISSION EXP. APR. 1,202
TOTAL DUE 71**"
Structural Engineer
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