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77 NE 95 St (3)CONTRACTOR New Construction Name .e _ 4 jziai Name Address A s License No. 2 ...' 7 } 1 L - •() , Address ' i o rJ ,,..J 'IP J - 'A. i `(''7 Telephone , Fax Shell Only Qualifier Name e Foundation Only PROPERTY OWNER New Construction Name .e _ c Address A s � dL '' Home elephoneJ , / Business Telephone ' S Fax Shell Only TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior 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: 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 ma, be asked to submit additional information. APPLICATION ob Address: 7 7 AJ E 95 in,44,v1A, Address Apt. City Folio Number ( 32- O b ° 0 7 2-2) Lot ( Block Subdivisiontaiy, PB PG Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE • ( Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax • • Mar Permit No. - Pv t / 3 • i . • st • • • • • S tibsit�ary Permit No. ••• • • • • • • • • • • • • • ••' •• ••• •• Complete the attached permit applicati ¶n Mikis must be :i*e4ty thtroperty owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accur be psocessjngjof:tier tplicatioa. If roofing work will be done, a roofing application must be submit- ted along with this permit application. • • • • • ••• • •' PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement! Reinspection escription of Work Zoning Square Feet 3313 State PERMIT APPLICATION Zip Linear Feet Units Floors ✓i) Value of Work 3 f ' 5C - -'" Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax ••• . • • •• • • Page 2 • • • • ••• • ••• • • ••• • . • • • • • • • ••• • • • • • • • PERMIT APPLICATION IMPORTANT NOTICES 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVEE.1fOUR VALIDATED PERMI'1 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 AKSI TI,VEA ti;A CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT • FREE FRp f VD11 )E$R$S. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY E2UIPJESIT )eNjE.HIZLES, 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 recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. worn to and subscribed before me this STATE OF „IRIDA,COJ]IVyAMI -DADE /r I . %J lil ! / I� cure of Notary Public State of • 'da "PA • Angela M Becker SEAL: , My Commission DD150048 a dd Expires November 15, 2008 Signature of Contractor / Qualifier -k✓ tea. 1,, Also -O (a SwSworn to .,,: subscribed before me this . day or /w \ Print N ame SEAL: re of No FLORIDA, COUNTY OF MIAMI -DADE My Commission 00150048 OP Expires November 15, 2006 Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: / '..-- 4/ '..-- 44 1 ) f � �� ' 7p� 3 V�' 1 /9 Type of Identification Produced: F^ !, 4 1 2 1-y.3 J `3r ELECTRICAL TYPE QTY. TYPE QT 1'. "1'V;'1: QTY. '1'11'E Q"1'V. Minimum Fee Generator Dryer ' • • • • . • • •I• Oytllt, Appliance Outlet, Wall A/C Central, Tons Service Repair Service, Temporary Cooling Tower A/C Central 1 -3 Ton Heating Strips, each Fan 1 A/C Central 4 -7 Ton Bidet Fire Pump Filter Replace Outlet, Switch Pool Piping Signs Sprinkler Repair A/C Central 8 -15 Ton Cap - Fixture Fixture - Fluorescent Fountain Oven Pump and Abandon Space Heater (kw) Sprinkler System A/C Central 16-20 Ton Cap - Water Fixture Light Gas - Appliance Parking Lot Lights Pump, Domestic Spas/Hot Tubs Supply, AC Well A/C Central 20+ Ton Cap - Sewer Flood Lights Gas - Natural Plugmold/Strip Pump, Fire Stand Subfeeds, No. of Amps Temporary Toilet A/C Window Catch Basin FPL - Load Central Gas - Propane Posts Pump, Re- circulate Swim Pool, Commercial Temporary Water Closet Air Conditioners Clothes Washer Garbage Disposal Gas Piping Range/Range Top Pump, Replace - Pool Swim Pool, Residential Urinal Chiller Dental Chair Generators, etc. Grease Trap Receptacles Pump, Sprinkler Switchboards Utility - Sewer Clear Violations Discharge Well Heat Recovery Ice Maker Refrigerator, Comm. (p/PH) Pump, Sump Temp Serv., Construction Utility - Water Compactor Dishwasher Low -volt, Burglar Indirect Wastes Refrigerator, Domestic Relay Repair Temp for Test - 30 days Vacuum Pump Deep Freezer Disposal Low- volt, Fire Interceptor Renew - Temp Service Roof Inlet Water Closet Demolition Domestic Well 1 Low -volt, lntercom/Teleph. Laundry Tray Repair Circuits Septic Connection Water Heater Dishwasher Drainfield, 4" Tile/Res. Low -volt, Television Lavatory Service, Number of Amps Septic Tank Water Heater New MECHANICAL TYPE QTY. TYPE QTY. 7'YI'E QTV. TYPE Q"1'V. Minimum Fee TYPE Drains, Roof Condensate Drain TYPE Miscellaneous Fixture Generator TYPE Soakage Pit Refrigeration, Tons Bath Tub A/C Central, Tons Drinking Fountain Cooling Tower Miscellaneous Repairs Heating Strips, each Solar Water Heater Vent Hood, Cost Bidet A/C Wall/Win. Tons Filter Replace Dryer Vents, Number of Pool Piping Paint Booth Sprinkler Repair Ventilation, Cost Cap - Fixture Air Handler, Tons Fountain Ductwork, Cost of Pump and Abandon Piping, Flammable Liquid Sprinkler System Periodic Inspections Cap - Water Barbecue Gas - Appliance Fire Sprinkler System Pump, Domestic Process/Pressure Piping Supply, AC Well Cap - Sewer Bath Fan - Vented, # Gas - Natural Fireplaces, Number of Pump, Fire Stand Pressure Vessel Temporary Toilet Catch Basin PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TYPE 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 Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 I • • • •• •• .. • • • • • ••• • • • • •• • • • •• • • •• • • • • • .•• • • ••• • • • • • • • PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being per -otmod 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) ••• • •• 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 Notary • • • ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM ; : (Septic / Sewr'r) • • • • • ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $ 6.0 p° $ 300 *OD $ 02 • 9 19 (sq.ft. = x/1000 x ¢.60) $ (¢.005 / sq.ft.) $ (¢.01 /sq.ft.) �c) ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: SECTION Zoning Electrical Mechanical Plumbing Fire Public Works Structural Building Official BY DATE /6 o3 • ••• -^ • • ..• • ••• • • • • • • • • • • • • • • •• • • • • • PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL • • • • (Attach) • • • ti APR APPROVAL (Restaurants) • • •• ❑ CONTRACTOR REGISTRATION (On File) TOTAL $5g/40 CONDITION OFAPPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Applicant: JEFFREY Owner: HILTON j ADDRESS: 77 ('■, Contractor Local Phone: ,) Parcel # 1132060130720 t 4/ (- Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/4/2003 Permit Status: DR. JEFFREY C. HILTON 800 E. BROWARD BLVD., SUITE 106 FT. LAUDERDALE, FL 33301 954 - 524 -9400 BANK OF AMERIC BANK OF AM ICA, FLORIDA ACH NE 95 APPROVED Permit Expiration: Pilo . 1:0 63 LOO 2?? 00 36 6 L060 6 2 2 L L L 8/3/2003 Plumbing Permit Permit Number: PL2003 -41 HILTON JEFFREY ST Contractor's Address: Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 E3OFT LOT 21 & LOT 22 BLK 5 LOT SIZE Fees: Description FEE2003 -726 Building Fee FEE2003 -727 Buildier's Bond FEE2003 -728 CCF FEE2003 -729 Notary Fee Total Fees: Amount $80.00 $300.00 $2.40 $5.00 $387.40 Total Fees: $387.40 Total Receipts: $0.00 Work: DRAINFIELD TO BE INSTALLED IN FRONT YARD If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, -which -must be paid -in- advance before calling - for another inspection. �� `3.27/631 2 t&de Oryt; $ 3 77 �L7 Vulev Construction Value: $3,500.00 1611 9 equipment or device described in the application herefor in strict compliance with all ith any plans, drawings, statements or specifications that may have been submitted to lot done in compliance with such ordinances or if the plans are changed without Dr or builder named above assumes the responsibility for a thorough knowledge of the s or in the statements or specifications and that he assumes responsibility for work done : ompliance with all ordinances and regulations pertaining thereto and in strict conformity Village. In accepting this permit I assume responisibility for all work done by either BY: BY: Page 1 of 1 • • ,••••• • • •• •• • • • • • • • •• • • • • • •••. • • • • •• •• • • • . #• • •••• •• •• • • • . •••• • ••.• • • • • •• • • . • • • • .• • •. — _ - - -- • • • • _ .•... -.• — — • • ••"' The Sunshine State ivause �6ER ••••••• J EF F y 7 59 '179-0 - Paw 7 N g 96–ST ,, T AIM , ►+crr. X38'0000 Ep A ARSE 01-16,97 p0' OPaa00 a;�u+o m Ota %mteb constitutes. • • � • • STATE OF FLORIDA ••�•. '• � '• • •:. DEPARTMENT OF HEALTH • • ••• � • • ONSITE SEWAGE TREATMESIT.%NQ PO AL :SYSTEM CONSTRUCTION PERMIT • • • • . • • • • ••• • . • CONSTRUCTION PERMIT FOR: • � • • • • ' LOT: 21 • • ••• • [ ]New System [ ]Existing System ( ]Holding Tank [ X ]Repair [ ]Abandonment• • • [• .J Te Dorary • • • • • • • • :• • A P P LICANT: Hilton, Jeffrey C. „ • A GENT : :SR090'0944, ALSTON HERMAN • • ••• •• PROPERTY STREET ADDRESS: 77 NE 95 St Miami FL 33138 BLOCK: 5 SUBDIVISION: Miami Shores [ ] Innovative Other [ NA ] [Section /Township /Range /Parcel No.] PROPERTY ID #: 11-3206-013-0720 [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOESNOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FA TS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K ( 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET A TYPE SYSTEM: [ ]STANDARD I CONFIGURATION: [ ]TRENCH N OTHER REMARKS: SPECIFICATIONS BY: Andre, Paul APPROVED BY: Andre, Paul SYSTEM [ N ]FILLED [ ]BED F LOCATION TO BENCHMARK: Finished Floor O f istin q Res. 10.4' NGVD Existing 900 Gallons Septic Tank To Remain. Install 200 Square feet drainfield. Invert elevation of the Drainfield to be NLT 8.9' NGVD Bottom elevation of the drainfield to be NLT 8.4' NGVD This permit is not for addition. TITLE: DH 9016 03/97 (Obsoletes previous gi n h_; �- , ic. -,.,.v .,.,,..,r.... -. _nn1_n ni c_n■ „ CENTRAX #: 13 -SG -15361 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 03 -0277- -R MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N ] I ELEVATION OF PROPOSED SYSTEM SITE [ 1.9 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.9 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 24.0 ] INCHES TEES h ir:, Hi7 i 1O.. FO5� �� '2 ISOTIMM[ OF DRA WJ .,F D FI TrWAIION ' d o TITLE: Professional Engin Dade DATE ISSUED: 1/30/03 78EH maLL ur; rx pED ,„pcp R,t ON DATE: 4/30/03 CHD Dmr.c 1 ,-f ') 1• . •. STATE OF FLORIDA •. .. • y• •� . ••. T�I DEPARTMENT OF HEAt' ; ••• : • • ONSITE SEWAGE THE ITM&TiiaNp PI SYSTEM CONSTRUCTION PERMIT • "' 1 • • • . •• 1 . • . . . . • � ••• CONSTRUCTION PERMIT FOR: �� • � • • • . [ ]New System [ ]Existing System [ ]Holding Tank [ X ]Repair [ ]Abandonment . . j •• ]Temporary • . • • • • • .• • 1.• • . • • •. • APPLICANT: Hilton, Jeffrey C. •�• • • :ALENP.:; SR09A0944, ALSTON HERMAN • • • • •.. .. 1 PROPERTY STREET ADDRESS: 77 NE 95 St Miami FL 33138 LOT: 21 BLOCK: 5 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -0720 1 [OR TAX ID NUMBER] CENTRAX #: 13 -SG -15361 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 03 -0277- -R [ ] Innovative Other [ NA ] SYSTEM MUST BE CCNSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY Tf-iE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. !ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK 1 A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ D [ 200 ]SQUARE R [ 0 ]SQUARE A TYPE SYSTEM: I CONFIGURATION: N F I E L D SPECIFICATIONS BY: Andre, Paul FEET PRIMARY DRAINFIELD SYSTEM FEET SYSTEM [ ]STANDARD [ N ] FILLED [ ]TRENCH [ V] BED LOCATION TO BENCHMARK: Finished Floor Of Existing Res. ELEVATION OF PROPOSED SYSTEM SITE [ 1.9 ] [ FEET BOTTOM OF DRAINFIELD TO BE [ 3.9 ] [ FEET FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: OTHER REMARKS: Existing 900 Gallons Septic Tank Remain. Install 200 Square feet drainfield. Invert elevation of the Drainfiel to be NLT 8.9' NGVD Bottom elevation of the drainfiel'd to be NLT 8.4' NGVD This permit is not for addition. 1 I I 1 TITLE: /1 , lU MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] [ N ]MOUND [ N ] [ N 10.4' NGVD ] [ BELOW] BENCHMARK /REFERENCE POINT ] [ BELOW] BENCHMARK /REFERENCE POINT [ 24.0 ] INCHES APPROVED BY: Andre, Paul 1 f TITLE: Professional Engin Dade CHD DATE ISSUED: 1/30/03 DH 4016, 03/97 (Obsoletes previous editionslwnich may not be used) C'7nn .__. -_ „ EXIR ' 0 Z TE: 4/30/03 1 Scale: Each block represents 5 feet and 1 inch = 50 fegt. • •• • • . • • • •• • • . .. •• • • . • .• • • ' • • • • . • .. • 1 j l ••• • • • • • i : 1 Notes: •.•; . :STATeORR•ORIDA : alAPINE'N- OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOiAL SYSTEM CONSTRUdT By _ w• •/ t7.to • • • loAfslif OH 4015. 10/98 (Replaces H(1s11 fam+4alb which may used) (Stock Numb•►: 6744.002.4016E Site Plan submitted by: I , �� Plan Approved • • • Permit Application Number • • •. • PART II - I� PLAN- .•• +S E . 11),) I i _ ce? 2 r.� L.— - �. c Signature 0 ■ Not Approved ALL CHAUJST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date /7 2j?/ j County Health Department Page 2 of 3 Scale: Each block represents 5 feet and 1 inch = 50 feat. • • 1• • • I re! 0.2 Notes: APPLICATION FOR ONSITE SEWAGE DISP 0114015.10196 (Rptacss HRS-H Form 4015 which may b• used) ck (Sa Nurtbw: 5744- 002.4015.m • ; • PA II -t • • A - T RIDA HEALTH ( AL SYSTEM CONSTRUCTION PER IT +• Permit Application Number �) ) 1 • I AN - • q,'T 71:c. k Site Plan submitted by: r * ` « i / Signature Title Plan Approved Not Approved Date - , By r 1 . ` County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 Type Insp' Permit No. Name MIAMI SHORES VILLA BUILDING DEPARTME 305- 795 -2204 Building inspection Request l Date ) Address Compa Phone # , C l For Inspector, C ° 3Name & Date Approved Correction Re- Insp'n Fee MORTGAGE LOAN DEPARTMENT 609 Congress Bldg. MIAMI, FLORIDA INVESTORS SYNDICATE E S T A B L I S H E D 1 8 9 4 MINNEAPOLIS, MINNESOTA Plumbing Inspector 9533 N. 4. 2nd Avenue Lliami Shores, Fla. G entlemen: AZC July 29, 19141 Res Case No. 09 -027260 A. H. Aohorn 69 N. E. 95th St., li. S. We are enclosing herewith FHA Form No. 2218 - Certificate of Inspection of Private Sewage Disposal System. Kindly execute this form in duplicate and return to this office in the self - addressed stamped envelope enclosed. Vie shall appreciate your usual prompt attention. Yours very truly, INVESTORS SYNDICATE Dat Type Insp'n Permit No. Name Address — Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Reque b For Inspector! 12) 03 Approved Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT c- 305-795-2204 Building Inspection Request Date Type Insp' Permit No. (J V Name -Address- Company Phone # For Inspector: Approyd Correction ❑ Re- Insp'n Fee Type Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Buildingjppection Request Dati \Time - Address_ 1 t . 9 r Company -f 44f4 Phone # For Inspector: 1) 1,%/ _ Na Approved Correction ❑ Re- Insp'n Fee ❑ k 20 03-1 �3