815 NE 99 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date'? j ` - Job Address Sts /1/L5 L5 `'/"9 ._. Tax Folio
Legal Description
Owner / Lessee / Tenant f:(1. Of, LJ/1//flJ24)
Owner's Address A /117c, 99 .5L
Contracting Co. ./IP,C1J11 Q i 1141 0/r1Pd)
WORK DESCRIPTION
Zo
Architect /Engineer
Bonding Company
Mortgagor Address
2e9 /Le s
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
Date:
** * * * * * * * * * * *
v
FEES: PERMIT V. RADON C.C.F. 1_ s NOTARY
Building Electric
Master Permit #
Phone 11 9D /9
Address I i9 UJ NLXL
Qualifier ai a i t 611 SS# Phone /
State #f11 / Inicipal # Competency # Ins.Co.
Address
Address
_J % Ji
Permit Type(circle one): BUILDING ECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost(value
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 AN 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing informat'on is accurate and that all work will
be done in compliance with all applicable laws regulating co and zoning. Furthermore, I
authorize the above -named contractor to do the work stat
Sig ure of Contractor or Owner- Builder
Notary as to Con r ctor or Owner-Builder
My Commission I xpir @ 1F C1AL NOTARY SEAL
EATRICE MEDRANO
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC280031
*1Y COMMISSION LOCI'. APR.X6,1997 **
TOTAL DUE .
APPROVED: Fire Other
Mechanical Plumbing Engineering
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 (CEO)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR GRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
.AUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
:LOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
;KKR
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
;INK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
;INK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
;INK, SLOP
TEMPORARY
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
RINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
CLOSET
RECT
MOTORS OVER 100 HP
V ION
VIOLATION
IOLATECTION
WASTES
ATER
A/C WINDOW
SUPPLY T0:
A/C
AIR CONDITIONERS
UNIT
FIRE
STRIP HEATER
SPRINKLER
HEATER
GENERATORS TRANSFORMERS
-NEW INST.
HEATER
GENERATORS TRANSFORMERS
- REPLACE
LAWN
GENERATORS TRANSFORMERS
SPRINKLER -WELL
SWIMMING
SPECIAL PURPOSE
POOL
WATER
OUTLETS COMMERCIAL
SERVICE
:WER
SIGN TUBES
CONNECTIONS
'ILITY
SIGN TRANSFORMERS
-SEWER
ILITY
SIGN TIME CLOCK
-WATER
PTIC TANK
FIXTURES
LAY
ANTENNA
AINFIELD,
TELEVISION OUTLETS
4" TILE/RES.
hP &
VIOLATION
VIOLATION
ABANDON SEPTIC TANK
AKAGE
PIT CU. FT.
TCH
00/)/M4 ) •
BASIN
SCHARGE
WELL
NESTIC
WELL
EA
DRAIN
)F INLET
WATER
.AR HEATER
tE
'ICING
INKIER SYSTEM
RANGE
ER SET
(GAS)
PIPING
AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
BTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date /5 / r Job Address g 1.5 NE 74 S7 !E EZTax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant ti A LJ ,(I/ S Master Permit #
Owner's Address Phone
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft Estimated Cost (value)
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 AN 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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. Furthermore, I authorize the above -named contractor to do the work stated.
FEES: PERMIT
1 a ature of owner and/ do President Date
Signature of Contractor or Owner- Builder Date
as to 0 er and/or condo President Date Notary as to Contractor or Owner- Builder Date
My F oiRptit s BOMAL NOTARY SEAL My Commission Expires:
0 e, SANDRA M MONTIEL
* COMMISSION NUMBER
Q CC401261
7, R` (p MY MY COMMISSION EXP.
4‘ OF O AUG. 17 1998
RADON
C.C.F. NOTARY TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering