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500 NE 95 St (7)TOWN # DEPARTMENT AMOUNT MARK X) ONE OR OTHER RESIINST COMM NST ° 1 q 34 .o o • 0 • • ( t ry , Contractor ADT SECURITY SERVICES INC - Local Phone: rl � Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: EL2002 -160 I Printed: 5/15/2002 Applicant: DOUGLAS BONHAM Owner: BONHAM DOUGLAS JOB ADDRESS: 500 NE 95 ST ADT Security Services, Inc. Parcel # 1132060140840 Fees: Description FEE2002 -2774 Building Fee Total Fees: Permit Status: Work: RENEWAL OF PERMIT #50292 LOW VOLTAGE BURGLAR ALARM SYTEM 1 CONTROL 5 DEVICES 031699 09 C fi Branchpay0 1 - (800) 444.6899 Another service of Gelco Information Network, Inc. Eden Prairie, MN PAYABLE THROUGH 64 -1278 NATIONS BANK OF GEORGIA, N.A. ATLANTA, DEKALB COUNTY, GEORGIA 611 Approved Permit Expiration: 11/10/2002 Construction Value: For Permits and Licenses Only TOTAL I 3 %,o0 Legal Description: 6 53 42 MIAMI SHORES SEC 2 PB 10 -37 LOT 12 BLK 55 LOT SIZE PAY TO THE (A ( ORDER OF 1 (NAME) (PA JEE Electrical Permit Contractor's Address: 7747 NW 48 ST 160 3 Amount $35.00 $35.00 SOCIAL SECURITY NO. Sei 3 541 a2s 5 BP AUTH. NO. ISSUE DATE , \ t S ( the e- (ADDRESS) .5'34° (CITY) AMOUNT OFIU 1 Al ‘C \ l5� - DOLLARS $ NOT GOOD FORE THAN $250 0 11'0 40 208 3 4 78 1:06 L1,127881: 0 L L 58 2 4511' 26696000 05 0402083,478 e>5229 NOT VAUD AFTER 60 DAYS FROM DATE (STATE) Pc NOT REDEEMABLE FOR CASH BY DRAWER'S AUTHORIZED REPRESENTATIVE SIGNATURE OF DRAWER'S AUTHORIZED REPRESENTATIVE By signing this instrument, each of the aloresigned confirms that This instrument has been drawn in accordance with the authority issued by Gelco Information Network, Inc. II any statement herein be untrue, we, the aforesigned, agree to pay the drawer upon demand the amount of this instrument and all expenses and damages arising from such misstatement Page 1 of 1 Total Fees: $35.00 Total Receipts: $0.00 nspection n herefor in strict compliance with all ons that may have been submitted to f the plans are changed without 'bility for a thorough knowledge of the he assumes responsibility for work done ertaining thereto and in strict conformity 3nisibility for all work done by either TOWN # DEPARTMENT AMOUNT MARK X) ONE OR OTHER RESIP6T COMM INST 0 / /`I 4o. � . o 0 ., 0 A SOCIAL SECURITY NO. BP AUTH. NO. ISSUE DATE 3 g3 - e5'cY-QZ J'S (,0,Z,9Y 1,1 031699 09 C • Branchpay m 1(600) 444.6899 Another service of Gefco tntormation Network inc. Eden Prairie, MN Security Services, Inc. S3? For Permits and Licenses Only PAYABLE THROUGH 64 -1278 NATIONS BANK OF GEORGIA, N.A. ATLANTA, DEKALB COUNTY, GEORGIA 611 TOTAL 6 D. vv PAY TO THE ORDER OF . THE AMOUNT OF I ain i S , (NAME) (PAYEE) w ADDRESS) GPI (CITY) NOT GOOD MORE THAN $250.00 0'040 188939311' 1:06 11 it 2 788: 0 1 1 58 24 5((' 0401889393 Zed- 26696000 05 NOT VALID AFTER W DAYS FROM DATE (STATE) DOLLARS $ NOT REDEEMABLE FOR CASH BY DRAWERS AVTHORIIED REPRESENTATIVE SIGNATURE OF DRAWER'S AUTHORIZED REPRESENTATIVE By " ng this instrument, each of the aforesigned cod= that Bee instrument has been drawn In accordance with the authority issued by War Information Network Inc. 11 any sia emend her& be untrue, we, the atoresigneth agree to pay the drawer Mort demand the amount of this bwhwnent and a1 expenses and damages arising from such misstatement PROPERTY OWNER Namf.. _- I Address 50 0-t. °1S S T Home Telephone 30 f , S) _ l . t ^� 4 4 �1 Business Telephone Fax CONTRACTOR New Construction Name A b; w � 4 . ` (� ,� / �/ Enclosure License No. EC1OL c ' � 9l Alteration Exterior Address "�1 y1 1\..,.(3 tTM Repair Telephone-At ?) )_19 0 ) Fax 3tsc. lo 29 cly Qualifier Name , ` t . 'day ,l ' " � Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior ,✓ Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: 50 N om. 95 S*5` 5 02.9 -- Address Apt. Folio Number Lot Block Subdivision PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Zoning PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name Address License No. Telephone Fax Description of Work Master Permit No. Subsidiary Permit No. SHovtb CC- City State PERMIT APPLICATION Zip Linear Feet Square Feet Units Floors Value of Work Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER License No. Name Address Telephone Fax Page 2 II\'I PORTA NT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. 1. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1°' Floor, (305) 679 -1078. Once recorded, the Notice of Commence gust be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Commence on Construction Lien Law and Choosing a Contractor. ST FLORIDA, C TY OF MIAMI-DADE Signature of Owner in 4 Print Name Sworn to and subscribed before me this 2 Z!' SEAL: Signature of Notary Public - State of Florida day of Type of Identification Produced: ALBA GAONA oN4ARY PUBLIC S7,'AT! OF PURIDA • *MMISS1(N NO. COMB Personally known Personallykno Signatur of Contractor / Qualifier , Print . me P Sworn to and subscribed before me this () day of Signature of Notary Public - State of Florida SEAL: , Y Type of Identification Produ PERMIT APPLICATION IDA, COUNTY OF MIAMI -DADE a.e1A- A , ' 4iOT R';:au ALBA GAONA s PUBLIC STATE OF FLORIDA d COMME8ION NO. ation ELECTRICAL TYPE: Minimum Fee QTY. TYPE: Dryer QTY. '►'YPE. Outlet, Appliance QTY. 'TYPE. Service Repair QTY. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service I)ispo:ml Demolition Low -volt, Intercom/Teleph. Repair Circuits l)ornestic Well Dishwasher Low -volt, Television Service, Number of Amps lira i I ( field, 4" Tile /Res. MECHANICAL TYPE. Minimum Fee QTY. TYPE: Condensate Drain QTY. TYPE. Generator QTY. Tv'PI: Refrigeration, Tons QTY. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Sprinkler Repair Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Pump and Abandon PLUMBING TYPE QTY. TYPE. QTY. 'TYPE: QTY. 'TYPE QTY. A/C Condensate Drains, Roof Miscellaneous Fixture Soakage Pit Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump I)ispo:ml Interceptor Roof Inlet Water Closet l)ornestic Well :.aunc.-y'.t`ray Septic Connection Water " eater lira i I ( field, 4" Tile /Res. :.. va'i ry Septic Tank Water Heater New I)raIa s, Area Meter Set (Gas) Sewer Connection Shower Water Re -pipe Water Service Draire:, Floor Minimum Fee I)ra:.us>, French i isceIaneous Equipment Sins Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical /3YmY Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) O FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) , $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) ISSUING OFFICIAL ( sq.ft. = x/1000 x0.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ 3 S CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com ELECTRICAL Tl'PE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair T1'. A/C Central 1 -3 Ton Heating Strips, each Fan Outlet, Wall Service, Temporary Paint Booth A/C Central 4 -7 Ton Fire Pump Outlet, Switch Piping, Flammable Liquid Signs A/C Central 8 -15 Ton Fixture - Fluorescent - Process/Pressure Piping Oven Space Heater (kw) A/C Central 16 -20 Ton - Pressure Vessel Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery , � Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burgla( / /21 rator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire 1 Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Ileater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New Drains, Area MECHANICAL TYPE Minimum Fee QTY. TYPE Condensate Drain QTY. TYPE Generator QTY. TYPE Refrigeration, Tons QTV'. A/C Central, Tons QTY. Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Number of - Pressure Vessel Gas - Appliance PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. I YI'E. Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry ¶ay Septic Connection Water Ileater l rain ie:d, 4" Tiie/liles. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Brains, French Miscellaneous Equipment Sink WcII, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Cl PROOF OF OWNERSHIP (Attach) O HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ lop m a $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE G /- (sq.ft. = x/1000 x ¢.60) (¢.005 /sq.ft.) (¢.01 /sq.ft.) PERMIT J PPLI€ATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Page 2 IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be reccrded at: 22 N.W. 1st Street, P' Floor, (305) 679 -1078. Once recorded, the Notice of Commencement A� be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Villa g ail on Construction Lien Law and Choosing a Contractor. STATE OF FLOJUDA, OUNTY OF MIAMI -DADE SignaJef Own Thaw /1, 7 r' Print Name Sworttto an subscribed before me this Signature of Notary Public - State of Florida SEAL: day of '1V'."`" , a G A kliW 91 ATE Of FLORIDA comwasstota CCS Personally known CO"+ e ' Type of Identification Produced: ATE OF FL IJ A,, OF MIAMI -DADE Sof Contractor / Qualifier �� Signatur a, t 9 ) Pei �f" 0 ll Print Name t Sx an subscribed before me this __S_ day of //� , Signature of Notary Public - State of Florida SEAL: ALFA GAONA IskitirAitY IUIltr Personally known OR, Produced Identification PERMIT ,AP ATION Type of Identification Produced: CONTRACTOR Name ./ 2 S � , S License No. e ` Du /‘0 Address 7 7V7 / VP , i ovs Telepho 7 /76J33s/ 4o 7 F � 3 2f , 2i d1 Qualifier ame A 7y4" 4 , /' /��� PROPERTY OWNER t ezvjec Kgyi Name j/k %v,1 Address 5Z //' rte'- 9S7- 'fd Home Telephone( X U 15) 25 --f . , 25 --f . , J 9 Business Telephone Repair Fax Alteration Interior TYPE OF MANAGEMENT (✓ ) New Construction �Ecl'closure Alteration Exterior v Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Fo/i agd PERMIT APPLICATION Master Permit No. Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: Bp • 0 / • ( o�' 1 Subsidiary Permit No. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Folio Number // '3 —) /f �� % Description of Work 23e , k F �t. (/ . �r Lot Block 1 t a A 5 - ' Subdivision PB PG ,� / - Zoning Linear Feet Current Use of Property �1.�Si J e fr Square Feet Units Floors Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Address Apt. i te_0de-n -i 4-e, PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Address Name License No. Telephone Fax Value of Work 353 ' Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. l �' l I A ,�, t �Ihaf� p2 313/ City State Zip k/ SNottFs,... � � ENGINEER License No. Name Address Telephone Fax