1255 NE 95 St (7).
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
1I - 3 DCe -p l Lt` Doc
Date /01/7 PP Job Address WS SS N , F , 9 s S + i Tax Folio
Legal Description Historically Designated: Yes No
Owner / Tenant 6/4;71Q Ana k lig, 7 f Master Permit # 47
Owner's Address /25 4& L c-5 F Phone
6 & igje 69.`exp,41, t , Address
A IV .0 IR L= S l !ILL g. SS# Phone '7' 5' —G 6 36 g■
Contracting Co.
Qualifier
o President
e"'"%,
MARLENE P. IVEY
' MY COMMISSION # CC 871056
"' :r EXPIRES: September 14, 2003
;s Bonded Thru Notary Pubtc Underwriters
Signature o owne and/or C ndo Present
1
No as to Owner and/or Co
y Commission Expires:
FEES: PERMIT RADON
zr
APPROVED:
Zoning
Mechanical / � ' `� l 1 3 `'' c ' j Plumbing
►olzDI 00
Date
Date
No
My,
C.C.F. J .. j u NOTARY
Building Electrical
Structural Engineer
L �� 5 s��a
State # / L Municipal # /J / , f I Competency # / CS-0 3 Ins. Co. S l PA 1) I
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING
� / ELECTRICAL PLUMBING MECHANICAL) ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 7 f ,t}- ( L¢-e 42€ o D74,
0
Square Ft. Estimated Cost (value) L, 3 . p
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 s ed.
Signatur f C ontractor or Owner
•
.4,Y ;y P. I
�� ; MY COMMISSION MARLENE # CC VEY 871056
14,--4,--1 EXPIRES: September 14, 2003
Rf ;h�'' Bonded Thru Notary Public Underwriters
7J as to Contractor or
ommission Expires:
uilder
er- Builder Date
BOND
TOTAL DUE 6, r, o
Date
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS '
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMP
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1 -- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 FP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 FP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8-- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTCRS OVER 10- 25 If
FIRE SPRINKLER SYSTEMS
URINAL
` MOTORS OVER 25 -100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 hP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
;EWER CONNECTIONS
SIGN TRANSFORMERS
ITILITY -SEWER
SIGN TIME CLOCK
ITILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA -•
,FLAY
TELEVISION OUTLETS
.RAINFIELD, 4' TILE/RES.
VIOLATION
UMP & ABANDON SEPTIC TANK
REINSPECTION
OAKAGE PIT CU. FT.
ATCH BASIN
ISCHARGE WELL
OMESTIC WELL
REA DRAIN
OOF INLET
OLAR WATER HEATER
IRE STANDPIPE
OOL PIPING
AWN SPRINKLER SYSTEM
AS RANGE
ETER SET (GAS)
AS PIPING
I
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