EL-03-303r.
Date /®
Legal Description 4iirJII Historicallly Designated:
Owner/L essee7tenet /i�!//'1 � � i -e S / e S ()A , M aster Permit # 1 03-303
Owner's Address l /l'- 9/
Contracting Co. fi f /4 d /& � . ) 4 C-
Qualifier fil. 4✓ / g. ' eL Seri ss#
State # -- O1 )/ t? Municipal #
//// it h • G'1il-7-i' / � r� • 0 3
Signature of owner and/or Condo resident Date
Notary as
My Co
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138 • Phone: 305 - 795 -2204 • Fax: 305
3 Job Address be ' €g• q (, ST Tax Folio
NANCY R. MCERLEAN
, • : N •tary Public - State of Florida
• I Commix an Expires Feb A,20119
d/oc tra4I lze@ adall 094 047
ssrdtr'tk£pires'"deri By National Notary Asan.
lo1(0 ��3
Phone
Address
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING / ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION: .2 S'/A, / /Ji b-i b'f /C / e 194 a / - kimeilep-
t
et.v. f 194 card. w rrk -e)Q$ 7i 1 * e '
Square Ft. Estimated Cost (value)
3 Vie.
Competency # Ins. Co.
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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 all disciplines.
OWNERS AI' 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. Furthermore, I authorize the above named contractor to do the work stated.
Signature of Contractor or Owner Builder
Notary as to
My Comm io j
1 )l (A t.o—
ECEHVED
OCT 0 8 2003
6 8972
Yes No
5T J 3 / r �'
Phone
b/ / 0.,3
Date
4,0"%,„ " NANCY R. MCERLEAN
z a �►�, L Notary Public - State of Florida
= MyCommetionF�ireiFeb20,2006
r.
Commleeion # DD 094
{ i3 . G ?ii a 1 1:, ai NOtaryAasn.
o 7
Date
FEES: PERMIT #/; C'V C ✓ � 2 RADON •C.C.F '10 NOTARY �, ('�� BOND
APPROVED: P1 W' U Q 16 / � �-` Y tech- TOTAL DUE 4 ►. �ED WV
Zoning Building OCT 2 U PAID � / /l Electrical
•
Plumbing Structural Engineer
Type.Insp'n
Permit No.
MIAMI SHORES VILLAGE_
BUILDING DEPAR
305- 795- 2204
Buildi g Inspection Request
Date ∎vim l) Timc
Name ?A-
Address V 0), ' (. 1 U
Company TY\ cs- n A
Phone # 0 a ■ 6 31
For Inspector: / 7 I) ) 0 - Name.
Approved:
Correction ❑
Re- Insp'n Fee ❑
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN ALPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/I TER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR'
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER -
MOTORS 0- 1 IP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY T0:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER /le ie-w
Q
FIRE SPRINKLER
GENERATORS TRANSFORMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY-SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTURES
SEPTIC TANK
ANTENNA
_
RELAY
TELEVISION OUTLETS
ORAINFIELO, 4" TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
;ATCH BASIN
DISCHARGE WELL
)OMESTIC WELL
AREA DRAIN
ROOF INLET
•
SOLAR WATER HEATER
:IRE STANDPIPE
'OOL PIPING
.AWN SPRINKLER SYSTEM
3AS RAND
EETER SET (GAS)
3AS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL