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54 NE 97 St (3)MIAMIjHORES VILLAGE^ Paint Color Approval and Agreement DATE: 1 / 2 0( - 754/-/ 3 y> OWNER'S NAME: S e— L AL-3sGvx._ PHONES 3 °S) — ADDRESS: -'/ /1/6 97 Sf / Sc)7 • xexcf Signature of Owner APPROVED: * xx xxxx * ADDRESS OF SITE: CONTRACTOR & LICENSE (if applicable) COMPANY NAME: site must be listed All Elements on t Walls Fascia Drip Cap/Drip Edge ( ,t )k,( Soffit Roof Flower Bins Shutters Awnings Chimney Doors and door jams Garage Doors Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings Other xc *xxxc ** �(cxxcxxxxxcxx* PHONE: xxxx* 4cxxxxxxxxxxx****** and,i the color to be painted. r cl ()Go - (� 0 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. / /Z6'- -v Signature of Contractor Date Date WHEN PAINTING IS FINISHED, CALL FO FINAL INSPECTION a:A (JO 0 Building Of`cial Date 4/23/01 PROPERTY OWNER Name `' d/r` Z, f e.il Address .9 U5 97 / 414 )/ 5 c' I(. 37(3g Home Telephon(3 ) -7 i3,[/� Business Telephone(3,0 /cf _2 P, 6 ' Fax TYPE OF MANAGEMENT (/ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'I Detachment Other V 'PR ..fil ®.NS - The, ilollowin be takon fo obtain a from the,l\'liami Step 1. Step 2. 5 y , 97 Si- — Address Apt. Folio Number t) I 3a0 (p D13 �! Job Address: Lot Complete the attached 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. 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. Block Subdivision rf S )r,) PB >' 0 Current Use of Property Proposed Use of Property Tenant Information PERMIIT TYPE ('1 ) ]Building Electrical Mechanical ]Plumbing LPGX Roofing Fence Other Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax PG /) 0 Zoning Linear Feet Square Feet Units Floors Value of Work) 40 ' d Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIIT CHANGE ( ) &1 /0 Master Permit No. /1w /vies City State Description of Work PERMIT APPLICATION Subsidiary Permit No. Zip ENGIINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 I :NI PORTANT NO 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. STATE 0 " ORIDA, COUNTY OF MIAMI -DADE Signature of Owner Signature of Contractor / Qualifier SEAL: L,t/sdII Print Name / Print Name Swum to and subscribed before me thisc?L' day ofki Q tJ urc of No .r Public - to of Fl: rich Ai' =L A •1:■ } * =M U:: oy CC7dS397 Sworn to and subscribed before me this day of STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Notary Public - State of Florida SEAL: PERMIT APPLICATION Personally known 012, Produced Identification /_ / Personally known OR, Produced Identification Type of Identification Produced: L ._.�./ io /� - 8 • 0 (9 C.// ()Type of Identification Produced: PLUMBI'NG I `'l 1'1 F A/C Condensate I'1'. QTY. TYPE Drains, Roof 1'Y. . '. 1'1'1 1� Miscellaneous Fixture QTY. I'1' TYPE Soakage Pit QTY' ._�._ Bath Tub Vent Hood, Cost Drinking Fountain Miscellaneous Repairs Fire Pump Solar Water Heater Paint Booth Bidet Ventilation, Cost Filter Replace Fixture - Fluorescent Pool Piping Ductwork, Cost of Sprinkler Repair Cap - Fixture Fixture Light Fountain Barbecue Pump and Abandon Fire Sprinkler System Sprinkler System Flood Lights Cap - Water Gas - Appliance Bath Fan - Vented, # Pump, Domestic FPL - Load Central Supply, AC Well Pressure Vessel Cap - Sewer Gas - Natural Garbage Disposal Pump, Fire Stand Temporary Toilet Catch Basin Generators, etc. Gas - Propane Pump, Re- circulate Temporary Water Closet Heat Recovery Clothes Washer Gas Piping Pump, Replace - Pool Low -volt, Burglar Urinal Dental Chair Grease Trap Low -volt, Fire Pump, Sprinkler Utility - Sewer Discharge Well Low -volt, Intercom/Teleph. Ice Maker Pump, Sump Utility - Water Low -volt, Television 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 ICL 'RA EEE �T TYPE Minimum Fee QTY TYPE Dryer QTY TYPE Outlet, Appliance T,. QTY. TYPE Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Vent Hood, Cost Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Paint Booth Signs Ventilation, Cost A/C Central 8-15 Ton Fixture - Fluorescent Oven Ductwork, Cost of Space Heater (kw) A/C Central 16 -20 Ton Fixture Light Parking Lot Lights Barbecue Spas/Hot Tubs Fire Sprinkler System A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps Bath Fan - Vented, # A/C Window FPL - Load Central Posts Pressure Vessel 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 Demolition Low -volt, Intercom/Teleph. Repair Circuits Dishwasher Low -volt, Television Service, Number of Amps r.'*qr'+�= c -- -^-rte- _;ate,.-- ,. -. sr - _ _. MECHANICAL TYPE QTY. TYPE Minimum Fee Condensate Drain QTY. -..., r--'.'*'• t-'- °'--- _— _— ..- ..-- -- •- ^- �,- ' --..' •z.^.n+,� TYPE QTY. Y. 1 YPI: QTY. Y. Generator Refrigeration, Tons 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 Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel 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 , /a /3j °/ Zoning Electrical Electrical Mechanical Plumbing Fire Public Works Structural `7 / Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) U CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PI R\II'I' 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 REVIEWED AND PREPARED BY: (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 $ 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 SUSAN LAWSON 12-00 305- 218 -2820 74 N.E. 97TH ST. MIAMI SHORES, FL 33138 -2331 Pay to the order of Bank ofAmerica. 0 . ACH R/TT 063000047 For �' Pen/h4J14 Q,. �/� f �^ l/�NLY�'y., Date 6 e C /s 1 ,0c) Don $ O 2192 - 4/630 Fl 1348 Sonny %rum 000 6 30000 700 00 3 7 l8 Q b0 ? 5 2u ° 2b92 The Sunshine State UCEISE Id1MaER L250-553 t;0-8 5-OO ISSUED EXPIRES 02-25.58 10-25-04 F:3 MICHELLE MARIE LAWSO 1 1501 X175 TERRACE PLANTATION, FL 33317-0000 BIRTH DATE SEX NOT REST ENDORSE 10 -26-80 F 6-04 A DUPLICATE 05 -07 -01 SAFE DRIVER . R030108070077 Operation of a motor vehicle constitutes consent to any sobriety test required by law, IWIIAMI S RES V Paint Colo' proval and Agreement DATE: 1 OWNER'S NAM : 9,LQ, , l,k /$/:1}'1 PHONE:_ 1 5 ADDRESS: flfl 97 7 )1 �• ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * ** ADDRESS OF SITE: , 9- n 5" e CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia Drip Cap/Drip Edge Soffit n Roof f R lt- e,oaf ne_eds Flower Bins r) /A be ciee&iec. Shutters n I A Awnings t Chimney OSY Doors and door jams Garage Doors (A1-17 jz t ni ok) L i` � L nIR Railings Fences "1\JU` Decorative Metal All brick (simulated or regular) r) / A Stucco Banding f I14 Any other stucco features Accessory Buildings f Other PE -2 * OWNER'S A1FFIIDAV1<T: 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached sa Al 1 ignatu Hof Owner D. e Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: Building Off 'al Date WHEN PAINTING JIS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PROPERTY - A. 1 M" OWNER Nam�y y I, Ad n dres SlIreiLl Home Telephone 3 -7 5 L1 [ j 3 Business Telephone3 ` 7 j 5 --7 _ / 7Q) �I Fax 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 IMMECC71:105W =`III followin obtain OCiafate luau Oros Whaot bore 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. n� I'Pl1'kAT1 ION '' lid let S hore s � ``aa ^ n n Apt. City Folio Number /i 3 aaoe, U,13 " / C/ , Job Addres . �1 f c / Block , g. S �� Q Subdivision PB PG 5 Linear Feet Current Use of Property Units Floors Proposed Use of Property Tenant Information Lot PERMIT TYPE ( ) ]Building Electrical Mechanical Plumbing LPG% Roofing ]Fence Other PERMIT CHANGE ('1) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Description of Work Master Permit No. Subsidiary Permit No. Zoning Square Feet Value of Work '56D. nO Tax Assessed/Appraised Value Flood Zone State D PERMIT APPLICATION Zip Bldg Value Base Floor Elev. ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 11IPORTANT NO"1'10ES 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. STATE OF FLO DA, COUNTY OF MIAMI -DADE Signature of Own ILLc AA-Q_ l U c 52)n Print Name wom to and subscribed before me this of tary Pu SAJ ,bh. of Flo da SEAL: SEAL: STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Contractor / Qualifier Print Name Sworn to and subscribed before me this day of Signature of Notary Public - State of Florida PERMIT APPLICATION FF1Ct ���; �F_�l pnY PP°6' A FLA u .�; I'L: on Iiy known .!i P dm d Id:nAM545Y�rF1n Personally known OR, Produced Identification Type of ldcntifcation Produced. _ `' "F" .:. _) ) ' Type of Identification Produced: SECTION BY D E �� Zoning G�Q Electrical Mechanical Plumbing Fire Public Works Structural Building Official %---- 7 Page 4 OFFICE USE ONLY • OWNER - BUILDER FORM (Attach) U FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ® CONCURRENCY (New Construction) LI OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) Code Enforcement Fine Zoning Review LI PROOF OF OWNERSHIP (Attach) HRS / DERM APPROVAL (Septic / Sewer) LI IMPACT FEE (New Construction) PLRAi1'F PETS Metropolitan Dade County (C.C.F.) $ • (C> v OTHER (Specify & Attach) $ (sq.ft. = x/I000 x0.60) (¢.005 /sq.ft.) (0.01 /sq.ft.) PERMIT APPLICATION Ul CONDO ASSOCIATION APPROVAL (Attach) C9 BPR APPROVAL (Restaurants) LI CONTRACTOR REGISTRATION (On File) REVIEWED AND PREPARED BY: DATE: t, mi TION Or511 A Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 o http:/ /www.miamishoresvillage.com ELECTRICAL TYPE Minimum Fee cm'. TYI,I,, Dryer QTY. TvI,I,. Outlet, Appliance QTY. TYPI; Service Repair QTY. A/C Central 1 -3 Ton Soakage Pit Fan Bath Tub Outlet, Wall Drinking Fountain Service, Temporary Miscellaneous Repairs A/C Central 4 -7 Ton Solar Water Heater Fire Pump Bidet Outlet, Switch Filter Replace Signs Pool Piping A/C Central 8 -15 Ton Sprinkler Repair Fixture - Fluorescent Cap - Fixture Oven Fountain Space Heater (kw) Pump and Abandon A/C Central 16 -20 Ton Sprinkler System Fixture Light Cap - Water Parking Lot Lights Gas - Appliance Spas/Hot Tubs Pump, Domestic A/C Central 20+ Ton Supply, AC Well Flood Lights Cap - Sewer Plugmold/Strip Gas - Natural Subfeeds, No. of Amps Pump, Fire Stand A/C Window Temporary Toilet FPL - Load Central Catch Basin Posts Gas - Propane Swim Pool, Commercial Pump, Re- circulate Air Conditioners Temporary Water Closet Garbage Disposal Clothes Washer Range/Range Top Gas Piping Swim Pool, Residential Pump, Replace - Pool Chiller Urinal Generators, etc. Dental Chair Receptacles Grease Trap Switchboards Pump, Sprinkler Clear Violations Utility - Sewer Heat Recovery Discharge Well Refrigerator, Comm. (p/PH) Ice Maker Indirect Wastes Interceptor Temp Serv., Construction Pump, Sump Relay Repair Roof Inlet Compactor Utility - Water Vacuum Pump Water Closet Low -volt, Burglar Dishwasher Refrigerator, Domestic Disposal Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service I)raintield, 4" Tile/Res. Demolition Low -volt, Intercom/Teleph. Repair Circuits Drains, Ai•i'a Meter Set (Gas) Dishwasher - Sewer Connection Low -volt, Television Water Re -pie Water Service Service, Number of Amps _ Drains, Floor Minimum Fee MECHANICAL .rvpi.. Minimum Fee QTY. TYPE Condensate Drain Q'i'V TvI,I,: Generator QTY. .LVPE Refrigeration, Tons QTY. A/C Central, Tons Soakage Pit Cooling Tower Bath Tub Heating Strips, each Drinking Fountain Vent Hood, Cost Miscellaneous Repairs A/C Wall/Win. Tons Solar Water Heater Dryer Vents, Number of Bidet Paint Booth Filter Replace Ventilation, Cost Pool Piping Air Handler, Tons Sprinkler Repair Ductwork, Cost of Cap - Fixture Piping, Flammable Liquid Fountain Periodic Inspections Pump and Abandon Barbecue Sprinkler System Fire Sprinkler System Cap - Water Process/Pressure Piping Gas - Appliance Pump, Domestic Bath Fan - Vented, # Supply, AC Well Fireplaces, Number of Cap - Sewer Pressure Vessel Gas - Natural Pump, Fire Stand PLC1113ING 'fl'I'E TV. TYPE QTY. TYPE QTY. TYPE QT1'. 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 Indirect Wastes Interceptor Pump, Sump Relay Repair Roof Inlet Utility - Water Vacuum Pump Water Closet Dishwasher Disposal _ Domestic Well Laundry Tray Septic Connection Water Heater I)raintield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Ai•i'a Meter Set (Gas) Sewer Connection Water Re -pie Water Service _ Drains, Floor Minimum Fee Shower Drains, Fr nrh Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED) ANI) REVIEWED BY: DATE: