1225 NE 96 St (7)MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ ,
ELECTRICAL ❑ DATE % i to 1954
PLUMBING ❑ PERMIT N° 9285 Contractors 4 r
License No
ROOFING ❑
Work to be performed under this Permit 7 LA
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
CONTRACTOR OR BUILDER
1j
t , fI J c • t `
Bl.
Subdi-
vision
BY
"y
F
Sq. Ft
Address of ' f Value of
Building 1 P l� /* 4 j ( Project $
INSP ECTOR
Amt. of
Permit $
AUTHORITY
/, t
This 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
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if 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
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees. '�
Signed: f"
In consideration of the issuance to me of this permit I agree to perform the work covered herggnder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications, sub tted to.„. the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either, myself, my agent, se ant or employee.
Miami Shores Village
10050 NE 2nd Avenue
Printed: 8/28/2002
Applicant: EUGENIA
Owner: SCHATZLE
JOB ADDRESS: 1225 NE 96
Parcel # 1132060143800
Permit Status: Approved Permit Expiration: 2/23/2003
Work: REPAIR DRIANFIELD
Plumbing Permit
Phone: 305 - 795 -2204 Permit Number: PL2002 -224
• SCHATZLE
EUGENIA
ST
Contractor LLOYD NORTH DADE SEPTIC TANK SERVIOrdNCtactor's Address: 750 NW 107 ST
Local Phone: 305 - 754 -3375
Legal Description: 5 6 53 42 MIAMI SHORES SEC 3 PB 10 -37 LOT 11 & E25FT OF LOT 12 BLK 83 LOT
Fees: Description Amount
FEE2002 -4785 Building Fee $80.00
FEE2002 -4786 CCF $1.20
FEE2002 -4787 Notary Fee $5.00
FEE2002 -4788 Buildier's Bond $300.00
Total Fees: $386.20
Total Fees: $386.20
Total Receipts: $386.20
Construction Value:
$2,100.00
Page 1 of 1
A 1 '' If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
'-0 3 fee is $50.00, which must be paid in advance before calling for another inspection.
This 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 herefor in strict compliance with all
ordinances pertaining thereto a d with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
- ' "i and approved by the proper m cipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further conditi upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pe . fining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
--...fl by his agents, servant • emp • ees.
i
Signed: , 1 N i, /, -. / (INSPECTOR) BY:
In consideration •f t VT nce 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, dra , s, 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.
"." "-- (1
Signed: (Contractor or Builder) BY:
PAY
TO THE
OBOE B OF
•FOR
LLOYD NORTH DADE SEPTIC
750 NW 107TH ST.
MIAMI, Fl 33168
•
e JJ l/
Washington Mutual
Washinggtc Mutua•Ba,
North Miam ilth Avenue nk Fin ancial Center 1746
12600 NW. 7 Avenue 1.800.788.7000
North ami, FL 33168. /CV •9',S 24 Werner Service
L�.t at /oc .9'J 7JL 4 f-
0 002336'x' ':26 7084L3L':L9 3111 200 9 2 3811 5u'
WARREN B. SCHATZLE
EUGENIA V. SCHATZLE
. Pay
to the order o
Bank of America.
ACH R/F 06310 7
Memo
lAii
DATE
':063 L00 2 ? ?': 0000300 L 3 L8 6" 6 L80
ISOLLARS L!J
2336
63- 8413/2670
Bank of America Advantage'
6180
63- 27/631 FL
U �Op o - f Z 960
Dollars PEI *et Ma
0
Scale: Each block represents 5 feet and 1 inch = 50 feet.
— Lt, a, ez
GGF
Site Plan submitted y: N-
i b
L L -- 0 - ayrignature
Not A
DH 4015. 10/96 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744 -0012- 4015.6)
PART II - SITE PLAN
Pitt �?o .u6-
(3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PT
Permit Application Numb�c y '
I 'ILJ
r I-
I
1' E
1I I
I1 I
*cam-
SLPT�C TAti
TRr
VOA
:c
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Notes:
.Sya - rem F/4'L) L Z uZ TO I i v.DQI; I /I. / c Q v`i Lt ,7Z 0 ") '5 �L
9L, vP EL- 7 ,r� Am t ��a�� , F�., 35137
t''; (ic u` ic° 7 t
Title
Plan Appr ed pproved Date
B County Health Department
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
:ICANT: / I M - N L' /V 55/// 7-2%!6:- AGENT: L L 0.7D it�oipT/d.
c
/ ^ BLOCK: 4 0 SUBDIVISION: 11 l / I f/ c� /0 07: C J
'ERTY ID #: //_ - 0/z-1 _ 3 J0 [Section /Township /Range /Parcel No. or
3E COMPLETED BY ENGINEER, HEALTH UNIT
/IDE.REGISTRATION NUMBER AND SIGN AND
PERTY SIZE CONFORMS TO SITE PLAN:
AL ESTIMATED SEWAGE FLOW: jini2
HORIZED SEWAGE FLOW:
39tUCTED AREA AVAILABLE:
l !.\
CHMARK /REFERENCE POINT LOCATION:
VATION OF PROPOSED SYSTEM SITE IS 2 ,{INCH T] (ABOVVEM1) BENCHMARK /REFERENCE POINT
MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
FACE WATER: Af,AJ. FT DITCHES /SWALES: ALA' FT NORMALLY WET? [ ] YESAM[ ] NO
LS: PUBLIC: 0./1. FT LIMITED USE: 4).4. FT PRIVATE: /U,4 . FT NON- POTABLE: jr) FT
LDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: in FT
10 YEAR FLOODING? [ ] YES [-1
NGVD
E SUBJECT TO FREQUENT FLOODING: [ ] YES [N O
YEAR FLOOD ELEVATION FOR SITE: L S ( "! NGVD SITE ELEVATION: ,7
L PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
,nsell # /Color
s//
7 .
11
)1
f
11
3DA SOIL SERIES:
Depth
p// to
to
/O'/
/0 "
to
to
to
to
» :to
to
11 to.7 i/
o7 �h,JLf7&$
3ERVE1! WATER TABLE: /U -11 INCHES [ABOVE / BELOW] EXISTING GRADE.
PIMATED WET SEASON WATER TABLE ELEVATIO L/ [ ABOVE
3H WATER TABLE VEGETATION: [ ] YES (4 NO MOTTLI` . ] YES [
TE EVALUATED BY: /3� �
4015. 10/96 (Replaces HRS -H Form 4015 (Page 3) which may be used)
ock Number: 5744-003-4015-1)
EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
YES [ ] NO NET USABLE AREA AVAILABLE: V - ,2- ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: G,>r, SQFT
f/,J /iAl 7)
Munsell # /Color
o /
/ Q
GRA/
1l
/1
/1
1
USDA SOIL SERIES:
Texture Depth
L h,tJ lv1 y ,( i/ to
. /iNn t 14
�St7.t1� //) to
' 5. 4 0 1 /2) to
// to
// to
Ir
1/ J,Pf 44 AND
to
to
to
-7
TYPE: (PERCHED / APPARENT)
EXISTING GRADE.
EPTH: N -J9 ' INCHES
Tax ID Number)
DEPTH OF EXCAVATION: at) INCHES
IL TEXTURE /LOADING RATE FOR SYSTEM SIZING• /•0
AINFIELD CONFIGURATION: [ ] TRENCH [JBED [ ] OTHER (SPECIFY)
MARKS /ADDITIONAL CRITERIA:
DATE:
Page 3 of 3
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
APPLICANT: Schatzle, Warren AGENT: SR0001343, Crockett Lester
PROPERTY STREET ADDRESS: 1225 NE 96 St Miami Shores FL 33138
LOT: 129 BLOCK: 83 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 014 -3800 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED 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 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 [
A [
N [
K [
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
600 ]Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: ]STANDARD [ N ]FILLED
I CONFIGURATION: [IN ]TRENCH [�J I ]BED
N
F LOCATION TO BENCHMARK: Top of The Bottom Floor, 10.03'
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.7 ] [ FEET
E BOTTOM OF DRAINFIELD TO BE [ 5.2 ] [ FEET
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED:
OTHER REMARKS:
This permit is not for addition(s).
*Existing 600 gl. septic tank to remain.
*Install 300 sq.ft. of drainfield.
*Invert elevation to be no less than 5.30' NGVD.
*Bottom elevation to be no less than 4.80' NGVD.
THE SEPTIC L F';:" "3N.T.3f' "71.*
DEFLECTIOR 11:•:38 — :f6 v:d YS'7: . S ?i°:3 TEE
SPECIFICATIONS BY: Icaza, Carlos
APPROVED BY: Icaza, Carlos
DATE ISSUED: 8/27/02
L„, c9
]Holding Tank ( ] Innovative Other
] Temporary [ NA ]
TITLE:
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) [ostds_cone 4016 -1I
TITLE: Engineer I
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
[0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
NGVD.
] [ BELOW BENCHMARK /REFERENCE POINT
] [ BELOW BENCHMARK /REFERENCE POINT
[ 30.0 ] INCHES
CENTRAX #: 13 -SG -13902
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 02 -2512- -R
THI3F.5.nril";f3;;,7r :77 .... .fLf5 31
BOTTOM F � :...:.:, ;:._ � ,..... ,:3i � • �0
Dade CHD
EXPIRATION DATE: 11/25/02
Page 1 of 2
ELECTRICAL
TYPE
Minimum Fee
QTY.
Tv1'1•:
Dryer
QTY".
Tvt'N.
Outlet, Appliance
(fry.
Tv1'i•:
Service Repair
QTY.
A/C Central 1 -3 Ton
Cooling Tower
Fan
Heating Strips, each
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Ventilation, Cost
Outlet, Switch
Air Handler, Tons
Signs
Ductwork, Cost of
A/C Central 8 -15 Ton
Piping, Flammable Liquid
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Bath Fan - Vented, #
Parking Lot Lights
Fireplaces, Number of
Spas/Hot Tubs
Pressure Vessel
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
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
I■1ECHANICAL
. LVP1.
Minimum Fee
()Ty.
nil:.
Condensate Drain
OT
.I'v
Generator
()Ty. . i , i• ,
Refrigeration, Tons
Q . I . v .
A/C Central, Tons
Bath Tub
Cooling Tower
Drinking Fountain
Heating Strips, each
Vent Hood, Cost
A/C WaWWin. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Pool Piping
Air Handler, Tons
Sprinkler Repair
Ductwork, Cost of
Cap - Fixture
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Gas - Appliance
Bath Fan - Vented, #
Pump, Domestic
Fireplaces, Number of
Supply, AC Well
Pressure Vessel
Cap - Sewer
PLUNIBING
"1'1'1'@
A/C Condensate
QTy.
l'YI'l
Drains, Roof
QTV.
TYPE
Miscellaneous Fixture
QTY.
Tv1'1•:
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
1'age 3
PERMIT APPLICATION
[ INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided belo�
RECEIVED AND REVIEWED BY: DATE:
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
LI FIRE DEPARTMENT
APPROVAL (Commercial /
multi - family)
❑ CONCURRENCY
(New Construction)
LI 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
Notary
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ 90
$ 1 t D) 0 ( sq.ft. = x/1000
x0.60)
$ (¢.005 /sq.ft.)
$ (¢.01 /sq.ft.)
$
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
dlZ,.,o1i
PERMIT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERNIIT FEES
TOTAL $ b V
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2' AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
Page 2
INIPORTANT 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 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.
STA FLORIDA, CO UN Y l i v en E
Se Zia
Sign. y.ef'Oyfier
(l er7ra V .5c%a?'2/e
Print Name
SS o� m� su
• F Giefr
Signature of lic - S • a ::. KE T
MY COMMISSION # DD 014762
SEAL:
* c_)
EXPIRES: May 20, 2005
1 4oFF, Bonded Thru Budget Notary Services
Personally known
Li- C'• C,PocXE
OR, Produced Identification
Type of Identification Produced:
Print Name
SEAL:
L4:272 / G'CoC e4: -
m to and subscribed before me this
PERMIT APPLICATION
tgnature o I No . Puth = S • too Flori
day o
Personally known OR, Produced Identification
Type of Identification Produced:
PROPERTY
/��1 OWNER
l
Name t AJ/? 7C.r / Cty/q 7LL
Address /. J C-""
/ 1' ,
4 � - Q /_ �� c yr - R E .- T
5 / /oEE FL, .33R/
Home Telephone
Qualifier Name LL6 i-4) L > C e -7 - ' r
Business Telephone
Repair
Fax
Alteration Interior
CONTRACTOR
Name ^,�
L LO yZ '\X 7H scppc
License No. � l 0 9 6 . 0 , / p
U � 1 �f Q
Address
LSD iv. �b��y .:5i,
nil lqfrn 1, r2 33/ a
Telephone . e ` " 9 /. 7676 Fax 3 .,` `9tr / / p 7
Qualifier Name LL6 i-4) L > C e -7 - ' r
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 1\Iiami 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 submit-
ted 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: f� AJ • 96 77 72?/ T �I //9M/ -/i/0.E- FL 33/34
Folio Number
Address Apt.
1) - 3J06- a /4 - .'�
Lot / / 4 Y % /j-4 Block O 3-
Subdivision PB PG
Current Use of Property L �/ AJCL
Proposed Use of Property C 11141L
Tenant Information A)- 19 .
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
7
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Fax
Master Permit No.
Subsidiary Permit No.
City
Flood Zone
PERMIT APPLICATION
State Zip
Description of Work ZE/z /A_ /I4(J / /EL Z
Zoning Linear Feet
Square Feet 3 i.) - 0 Units Floors
Value of Work $./L. 00
Tax Assessed/Appraised Value
Bldg Value
Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax