230 NE 94 St (3)'DING
ECTRICAL
JMBING
OFING
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ding
ect
,ctor
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ng
Lot
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PERMIT N? 11368
E
Work to be performed under this Permit
• •11`")1.- '611•`
Cb1QTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Bl.
f,
Subdi-
vision
Value of
Project $
DATE
Contractor's
License No
Amt. of
Permit $ '
"1 his 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
in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
gs, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
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
d is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and re
ring to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes reaponsib'
by his agents, servants or employees.
Signed
44:4" 41,46
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
'ng thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
oting this permit I assume responsibility for all work done .by either, myself, my agent, servant or employee.
)
BY
AUTHORITY
Permit No._ ___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.
Owner's Name and Address
Registered Architect and /or Engineer
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
`a-
Date �' S
✓
_ -- No.__.._ _-- __ — __
Employing Plumber's Name ° ( No.__ - _ -_ -_- —� Street--- - - -__
lr
Location and Legal Description Lot.______ ..... ________________ __ Block
Street and Number where work is to be performed— No._____ a' Street
State work to be performed and purpose of building (By Floors)...
New Budding ___ Remodeling.___ _-_ Addition.__ Repairs No. of Stories.
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 $
STATE OF FLORIDA, I es.
COUNTY OF DADE.
Subdivision
Capacity Gals
( Signed)- - — — -�
A
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.
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.
CLOSURE;
TUBS
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N8„,,
,5/. P'1 ' %
TOTAL
FIXTURES
GL IST
LIST
CHECK
6
(: �_
_ 1j
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELDS
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
POOL
CONTR.
LIST
,I
!'
` —_—
CHECK
i0
p
/ e)%
_
Permit No._ ___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.
Owner's Name and Address
Registered Architect and /or Engineer
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
`a-
Date �' S
✓
_ -- No.__.._ _-- __ — __
Employing Plumber's Name ° ( No.__ - _ -_ -_- —� Street--- - - -__
lr
Location and Legal Description Lot.______ ..... ________________ __ Block
Street and Number where work is to be performed— No._____ a' Street
State work to be performed and purpose of building (By Floors)...
New Budding ___ Remodeling.___ _-_ Addition.__ Repairs No. of Stories.
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 $
STATE OF FLORIDA, I es.
COUNTY OF DADE.
Subdivision
Capacity Gals
( Signed)- - — — -�
A
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.
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.
Permit No .1 Da te �g �' ` ' S
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 ........ •-- -_ -- ���`� !L__ _�_
Registered Architect and /or --
Engineer--- -_ / _-- - - --__ --
Employing Plumber's Name P• J e_.6
Location and Legal Description Lot.____.________ .___..__ __ _____ , Block
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__
Size Septic Tank_-_ _____________------------ - - - - -- Type of Tank
Feet of Drain ............. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.________________________ —___ Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. J
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No. 3‘/ _ Street_
CJ
Street )/ e 94/ .,27
(Signed) _
( Signed )_____
No._ Street____/YGU__S
Subdivision
Repairs No. of Stories.
Capacity Gals._
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.
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: 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
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
)/ e t
/�
---__
CHECK
Permit No .1 Da te �g �' ` ' S
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 ........ •-- -_ -- ���`� !L__ _�_
Registered Architect and /or --
Engineer--- -_ / _-- - - --__ --
Employing Plumber's Name P• J e_.6
Location and Legal Description Lot.____.________ .___..__ __ _____ , Block
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__
Size Septic Tank_-_ _____________------------ - - - - -- Type of Tank
Feet of Drain ............. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well.________________________ —___ Size of Soakage Pit
Amount of Permit $
STATE OF FLORIDA,
COUNTY OF DADE. J
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No. 3‘/ _ Street_
CJ
Street )/ e 94/ .,27
(Signed) _
( Signed )_____
No._ Street____/YGU__S
Subdivision
Repairs No. of Stories.
Capacity Gals._
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.
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: 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.
l-'e - it No.
L
Application is hereby mad 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. -
Gwnar's Name and Address
STATE OF FLORIDA, 1
COUNTY OF DADE. j
Location and Legal Description Lot.
Size Septic Tank
Feet of Drain Tile_ —
Nature of Water Supply: City —Well.
Amount of Permit $ C /
Registered Architect and /or Engineer.._1AP%
1 n s ��
Employing Plumber's Name 1 " 1 41111 u \ `- /1C / n`' `a !r No..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date A _ _ —I � /9' z
4 ___ -_ No _ —_— __ =._ Street_ Ai& 9
New Building —.. -- •-- •_ -.• - -- - - - - - -- Remodeling_ -. __ Addition__----_- •-- •----- _ -•_ -- Repairs
C Street____ IVE 'c
_Block Subdivision
7 6 .. Street.. 7
Street and Number where work is to be performed— No._______ _
State work to be performed and purpose of building (By Floors) _._ -- --- _---- -a(_1_ E' 4.AY a/ I r'
Type of Tank_ -- Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
- _-•--- _ -•- - -- - -_ -- -. Size of Soakage Pit
(Signed)_ -
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perinane
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors empl
performed under this permit; and will post or cause to be posted for inspection on the site of the work s
required by the Act. The undersigned agrees to employ only such sub - contractor on ' rk to be
licensed by Miami Shores Village.
No. of Stories.. _
My Commission Expires Notary Public, State of Florida
l- N-- `+=` =-
Plumbing'Th pebtor.
ofns as an employer of labor
upplement, and has corn -
by him in the work to be
notice or notices as are
nder this permit, as are
Before me, the undersigned authority, a notary public, duly authorized to a• . `'ster 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 worlonanchrip.
CLO..38`78
BATH
TLS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBE
U
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT•NS
TOTAL
FIXTURES
CONTR.
LicT
CHECtt
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
LIST
CHECK
l-'e - it No.
L
Application is hereby mad 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. -
Gwnar's Name and Address
STATE OF FLORIDA, 1
COUNTY OF DADE. j
Location and Legal Description Lot.
Size Septic Tank
Feet of Drain Tile_ —
Nature of Water Supply: City —Well.
Amount of Permit $ C /
Registered Architect and /or Engineer.._1AP%
1 n s ��
Employing Plumber's Name 1 " 1 41111 u \ `- /1C / n`' `a !r No..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date A _ _ —I � /9' z
4 ___ -_ No _ —_— __ =._ Street_ Ai& 9
New Building —.. -- •-- •_ -.• - -- - - - - - -- Remodeling_ -. __ Addition__----_- •-- •----- _ -•_ -- Repairs
C Street____ IVE 'c
_Block Subdivision
7 6 .. Street.. 7
Street and Number where work is to be performed— No._______ _
State work to be performed and purpose of building (By Floors) _._ -- --- _---- -a(_1_ E' 4.AY a/ I r'
Type of Tank_ -- Capacity Gals.
Dist. Feet of Tank or Drain Field from Well
- _-•--- _ -•- - -- - -_ -- -. Size of Soakage Pit
(Signed)_ -
The undersigned applicant for this building permit does hereby certify that he understands and accepts his oblige
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Perinane
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors empl
performed under this permit; and will post or cause to be posted for inspection on the site of the work s
required by the Act. The undersigned agrees to employ only such sub - contractor on ' rk to be
licensed by Miami Shores Village.
No. of Stories.. _
My Commission Expires Notary Public, State of Florida
l- N-- `+=` =-
Plumbing'Th pebtor.
ofns as an employer of labor
upplement, and has corn -
by him in the work to be
notice or notices as are
nder this permit, as are
Before me, the undersigned authority, a notary public, duly authorized to a• . `'ster 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 $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or worlonanchrip.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.1 / a' Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith 6/ubmitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall he complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owner's Name and Address ... • - - - - - -- - -- - - -- -__ -- -- _ No. __ . Street
Registered Architect and /or E i eer
Employing Plumber's Name -
Location and Legal Description ' Block Subdivision �L
Street and Number where work is to be performed —No. aL___:) __.__ __ Street l✓ f�$' / '
State work to be performed and purpose of building (By Floors)
New Building) __ - Remodeling Addition .__ _ _ Repairs
CONTR.
LIST
CHECK
CONTR.
LIST
CHECK
CLOSETS
SEPTIC
TANK
BATH
TUBS
SEWER
CONN.
f �
Size Septic Tank ‘
Feet of Drain Tile . __1__ 9�
Type of Tank______
Dist Feet of Tank or Drain Field from Well -
Nature of Water Supply Well Size of Soakage Pit
i
Amount of Permit $
STATE OF FLORIDA, )
COUNTY OF DADE.
SHOWERS
ss.
DRAIN
FIELD
LAVA-
TORIES
SOAKAGE
PIT
My Commission Expires
SINKS
SOLAR
H EATER
DEEP
WELL
GREASE
TRAP
SLOP
SINKS
LAUNDRY
TUBS
URINALS
SPRKLR.
SYSTEM
(Signed)
CATCH
BASIN
SWIM'G
POOL
FLOOR DRINKING /ST.S
DRAIN FOUNT' NS
3
Capacity Gals.
No. of Stories
Notary Public, State of Florida
--Vi a s s/
No. Street
Master Plumber.
TOTAL
FIXTURES
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.
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.
•
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical Plumbing) Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /Viet f. f �C� + ,7 f> Phone # -( 7 -tea
Owner's Address -;?::7:1r-) /J� 9 e / ; .
City ,e),- �,�'' ;t State
Tenant/Lessee Name
Job Address (where the work is being done)
City Miami Shores Village
Is Building Historically Designated YES
$ Value of Work For this Permit
4 --3f�1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
c 'i
County Miami -Dade
NO
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ 1 0 * SS
(Continued on opposite side)
Permit No. pi O((. !� N
Master Permit No. p ok-ks 7a-,
Zip .33t.
Phone #
Contractor's Company Name ift RAJ" t I�/1 E -, /' c ��r r �G' - � .. Phone # s l -. 0.& 4
Contractor's Address /c 4n - ‘ Cty' ' S A ,t' L' a
City AhAl-// State f / ' Zip ..3 i/
Qualifier /lc/
Architect/Engineer's Name (if applicable) Phone #
Zip 1
1 =,
Square Footage Of Work:
Type of Work: ❑Addition , EAlteration ) [ew ❑ Repair/Replace ❑ Demolition
Describe World ''.
* * * * * * * * * * * * * * * * * * * * * * * * * * * *F * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
****************************F
Submittal Fee $ 5 0 , 0 a Permit Fee $ / � CCF $ 'j 0 CO /CC
Notary $ Training/Education Fee $ - a Technology Fee $
Scanning $ Radon $ Zoning Bond $
w
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) /L2/1.T7'`/€ ) - T/2-05
Mortgage Lender's Address - 200 13g/ C14 t22
City m /A7n / State Zip 33/9/
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this to The foregoing instrument was acknowledged before me this
day of in , 2004, by lt)Ld,Am RDpE,tT . irit+ zr, day of 1 L/ , 20 i, by
who is personally known to meior who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
LYDIA FERNANDEZ
EXPIRES: July 25, 2004
1 �titd
Print: -;
My Commission Expires:
4
*************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
State Certificate or Registration No.
**** * * * * * * * * * * * * * * * * * * * * * * * * * ¥ * * * *
APPLICATION APPROVED BY:
Chc 12/15/03
r **
V
•
N
TARY PUBLIC:
Sign:
Print:
My Commission Expire
OFF AL NOT7AF S EAL
£COMMISSION NUMBER
, Q
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(Certificate of Competency Holder)
Certificate of Competency No.
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Plans Examiner
Engineer
Zoning
Miami Shores Village
10050 NE 2nd Avenue
Plumbing Permit
Phone: 305- 795 -2204 Permit Number: PL2004 -182
Printed: 8/4/2004
Applicant: WILLIAM ROBERT SMITH
Owner: SMITH WILLIAM ROBERT
JOB ADDRESS: 230 NE 94 ST
Contractor HERNANDEZ PLUMBING CO. Contractor's Address: 1840. S. W. 83 AVE.
Local Phone: 305 - 267 -2346
Parcel # 1132060133630
Permit Status: APPROVED Permit Expiration: 12/25/2004 Construction Value: $600.00
Work: POOL PIPING
Signed: (INSPECTOR)
Page 1 of 1
AUG 0 5 PAID
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 5 & 6 BLK 27 LOT SIZE SITE
Fees: Description Amount
FEE2004 -7812 Building Fee $150.00
FEE2004 -7813 CCF $0.60
FEE2004 -7814 Training and Education Fee $0.20
FEE2004 -7815 Technology Fee $3.75
Total Fees: $154.55
Total Fees: $154.55
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Total Receipts: f0.00
1 o‘l,ss
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations 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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY: