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967 NE 99 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 7/10/96 Job Address 967 NE 99 STREET Tax Folio / /--3 2 Q 6 — 0 41 © 7 co Legal Description S$'EG it Z( e LZ ,71(170 Historically Designated: Yes No ✓ Owner/Lessee / Tenant CONNIE LEVASSER Master Permit # O wner ' s Add NE 99 STREET, MIAMISHORES Contracting Co. LLOYD NORTH DADE SEPTIC Address 800 NW 111 STREET, MIAMI 33168 Qualifier DENNIS NEVILLE SS# Phone 754 -3375 State # 025836 -8 Municipal # Competency # 1284 Ins. Co. TRAVRT.RRS/ F.SIF Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): munamonsaumumippLumBING AIECALAMMxxlifiMINcRAYPRortlicRxxsifiaNcx WORK DESCRIPTION INSTALL DRAINFIELD Square Ft. 300 Estimated Cost (value) $1500 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 • . s i ction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFIN and i CHANIC all work'will be don in compliance with all applicable actor to do the work • ated. i OWNER'S AFFIDAVIT: I certify that all the foregoing information is acc laws regulating construction and zoning. Furthermore, I authorize the abov VAx...d.a,,, 7 - a.z - 9 Signature of owner Condo President Date FEES: PERMIT APPROVED: Zoning Mechanical n a �S RADON Notary to 0 er and/or C¢ndc\ Preside t Date My Co n Expires: wiSSSStiS w∎s.visvt.. �SS:wismwmc.aS�� Felddr ' Idotrry F`erHI.n ` o CO:ami:::cr. 1 ; > ''FoF re My Cc--irl'..:c z 13 :; irc G7/16/79 I. 800.3- ?:DTALlY - N.' .7 £,' li33 L Ea^ .7, Co. te'�and th named co e of Ccafitractor or Owne N tary a to Contractor My ission Expir iSSSSSSSSSC,SSSSSSSSSSSSSSS' �c A.v....., ...vm S . PU � B( Ter .:a . Felt::: ' S 3 1 T I Nolrryil::. . ,— "r.:rr ) '3, -,' .n Co: _P.�.. J< .^ ` . > ''oFP. .t My Cc .L-1...:2.� , :::1:!r:::: , Ci /1C/39 ' t ) 1. 200.3 - A:JT: �Y • rta. td. 42.7 "-'^r.:. ^ Er.:C^.3 Co. ' < !!!!!!!!l!!! f.'!!!!! tZ! lllCl!'!!l�tllld!!!C!C!!!l!! Phone 756 -6395 Builder 211 uilder Date Date c^c7 C.C.F. f NOTARY TOTAL DUE 3 6 . Building Electrical Plumbing Engineering CONSTRUCTION PERMIT FOR: [P1 New System [ /+ xisting System [\.)] Repair [ /Abandonment APPLICANT: Lr L PROPERTY STREET ADDRESS: LOT: ir.i , BLOCK: ,0 4 , A SUBDIVISION: PROPERTY ID #: / 1,3 -V fJ t l (/ 0 2_ 2 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED:- STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC G7 A 1 5�L CZIt/t TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) PERMIT # DATE PAID FEE PAID $ RECEIPT # Al/liplding Tank [ Temporary /Experimental her(Specify) AGENT: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, FAC REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 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. SYSTEM DESIGN AND SP C1FICATIONS T [7b ]ALL/ GPD SEPTIC TANK/AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: D [ 3 � SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ],FILLED I CONFIGURATION: [ ] TRENCH [ ) BED N , F LOCATION OF BENCHMARK: (). 114 IL - I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED:.[ ] INCHES [ ] MOUND [ ] [ [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] EfiE`S% T] [ABOVEnTran BENCHMARK REFERENCEPOINT) EXCAVATION REQUIRED: [ -A INCHES TITLE: « 9 i? 0- 5 16 7 f J. t ) / cI_ / %( [] EXPIRATION DATE: 1 of 2 _cify _ :ty o?wn:::'!; hot a _. _: �, ._.__ c': r��Gcr. :G or c∎;e . r .... , a y . )O tls�re�.r.' 'snw: ?n! .c:'_. • i:;. {C�.._� ,.ay ,:1�.. .,.. _. _... ._. . -AC. .. -•.. ...:?G ':J:a'!IlCCt1UP ;i• Sul':.. •.8 L1,. .,a II.i.. 7C_..._. i0C .!'J `'?l: - ^.t9 HOC! -01,._ ._., ;.!!15.3 eR!:CC Vrr:r.S_CC T::V? n'I .. am': U; !'.1dIV!C{! '� ' 7:V!.. JCIfiCCtion . f daJ! : :_ :c 5y C :r; r. , iaeer ;;._ LZ :)11za 2 .;`': County 2h:h'ic 1`ealt3 ;in. (C :=.:I.:11) person::•:? :avieveir):: etl r :3vin�t ,ate permit is issued by -a 11 i 1 em "3..co.... void` ,a . _ y ...,....._., from n;ao .: •uct: '.` .....::yst_r. i ?!�.., _..,: b :.,. i?:: :Td_._....: ,• Sys+ E .,_ 1 ,.;. • ; � l; - APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE E $ ALUATIONAND SYSTEM SPECIFICATIONS fit/A5 R.. LOT: BLOCK: PROPERTY ID #: 113 064:0402.1 0 SUBDIVISION: TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ YES [ ] NO NET USABLE AREA AVAILABLE: .157 ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: 59S GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE'_ UNOBSTRUCTED AREA AVAILABLE: eoo BENCHMARK /REFERENCE POINT LOCATION: Pf E• X).5 mSD ELEVATION OF PROPOSED SYSTEM SITE IS '1,1%5 [INOH8S /FT] [A /BELOW] EVENS /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: t(f) FT DITCHES /SWALES: -- FT NORMALLY WET? [ ] YES [J NO WELLS: PUBLIC: too FT LIMITED USE: '- FT PRIVATE: ° FT NON - POTABLE: FT BUILDING FOUNDATIONS: FT PROPERTY LINES: 5 FT POTABLE WATER LINES: is FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 10 YEAR FLOOD ELEVATION FOR SITE: W.'r 4-(2 SOIL PROFILE INFORMATION SITE 1 Munsell / /Color Texture USDA SOIL SERIES:S f Depth to to to to to to to to TEXTURE /LOADING RATE FOR SYSTEM SIZING: SITE EVALUATED BY: .�. 2 - K 1.25 HRS-H Form 4015, Mar 92 (Obsoles previous editions whi may not be used) (Stock Number: 5744 - 003 - 4015 -1) . PERMIT AGENT: 1 LOIP - NORTH' DAD S c [Section /Township /Range /Parcel No. o• Tax I' Numb SQFT UNOBSTRUCTED AREA REQUIRED: Expo SQFT [A] NO 10 YEAR FLOODING? [ ) ] TES [Y] NO FT MSL /NCVD SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 7 Munsell # /Color 0 USDA SOIL SERIES:. Nay Texture Depth SA.Nify - `-t°:12! to t o to to t t o t to OBSERVED WATER TABLE: 10 INCHES [ / BELOW] B ST ( GRADE. TYPE: [MAGI/MD / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: � E [ PAWS / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [ A NO MOTI:N1 [f J YES [A NO DEPTH: 0 INCHES DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [ ] TRENCH [ A] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: INCHES DATE: 7 Page 3 of 3 c,zn'31 iv 11! •• 27 nt• pmporty. (px..,pc:ety Gonfo::: to •.:17)77 • •:" .,•..,••• • •:•;" ;;;;;...;; •:*•;;-••• t."' o:•... .••:., : • '. :• • C7WC:C":. :1.); :". . 1 (::.;• ' 1"; i•L3 ;?, , • f0:1' : T.:: ,;;;;; -•:: .". ;.• . L:..,:;o1.211o..:;.••••;;;; _c.c. • ; ••.;:•••• • „ ' con'i., ' ) :0 1. ..•;, • v.,";*•.1/4;1•: /ctl.' • 01: 21i."17 :11 07 :•':' 2CC frnzi;:t on loVI: 1:::.1:11•,:ct to tioo.: :t to ic3- "..;;;.. i; V10 p. ..*... c•• ;•. :..•.•••• 1;V:um:a to;I::: • .. .. • iSDP: 1;o:: n;cord flt; : .. . ....;;\ • : rce,.:(116 of tit,: observ,:c", victor "■•..,I.;; t.n; •3r:1; o`:":••;: , 3•2 :•.• ;.• Wet ttinto: Sc :•••• 7.india•to :.• • • • ;" ( "? 11 % 1 -c• o th Q , :. • :•.t:";;•;.it1 to gito o: doftip.5 v••.11.2;•:..n anr: cit•te oi engin:con; iU3 (mntlt;::::•Ho:: • 1.] tat APPLICATION FOR: ] New System f< ] Existing System [ ] Holding Tank [0 ] Temporary /Experimental [t J Repair ] Abandonment ( J Other(Specify) APPLICANT: AGENT: MAILING ADDRESS: TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION LOT: BLOCK: PROPERTY ID #: PROPERTY SIZE: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC 4) 9 (;, ] Garbage Grinders /Disposals [t ] Ultra -low Volume Flush, T APPLICANT'S SIGNATU ] RESIDENTIAL No. bf Bedrooms n' r2 [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] SUBDIVISION: DATE OF SUBDIVISION: [Section/Township/Range/Parcel No.] ZONING: ACRES [Sqft/43560] PROPERTY WATER SUPPLY: [ [ ] COMMERCIAL Building # Persons Area Sqft Served PERMIT # DATE PAID FEE PAID $ RECEIPT 1 TELEPHONE: / Business Activity For Commercial Only DATE: 1- -� . 4 ] PRIVATE kc J PUBLIC ] Floor /Equipment Drains m ] Spas /Hot Tubs t ] Other (Specify) HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3 (Stock Number: 5744 - 001- 4015-1) _1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER IT Permit Application Number PART 11 - SITE PLAN 5 feet and 1 nch = 50 feet. 1 I� i 1 �_ i t 11_j i_ I _ H I III l J I Scale: Each block represents i G -� ' I I I I I I � � � iL I 1 _U_ I l _I . 1 LL = 1 I I i __I_ I I I I I j i I_ I I _._ I 1 i -1- 1 1- I , L _ I_ I ___, 1 1 I I_I __11_11 1 J I f I_ _ I_ - - I I 1_`I 1 _ _ - I( L l 1 I i I I I �. l -ll � - I l - i - i I I -L 1 - 1 J' r -1 _ I_- i _ I 1 _ ! 1 _ 1 . 1 I ,-I- I _ -_l I I I I � J_ - I _ l 1 I I I l d 1 1 � ] 1 l' I II I I I_I. 1. I l -I I I I I L I I- 1 1 1 1 1 I _ 1 1 1 1 .I — I I] 1 II_ t_ I I I- 1 1 1 1 r - I J I I . - - I � I- I I 1 I �_._ _ I 1 I , _ I j I I I J I 11' I i I i - 1 1 1 I I _ I _ I _ f - [I_ I — I �I l_ -11 �, 1 1 1 f I I 1 1 I I - I I I 1 I I i l I_ I_ I I Li{ , , I 1 1i l 1 t I [i i __ I 1 1 II III I ! I I I It1I `���$1 I ' _I 1 1 1 _ _ 1 I I ( I I I I 1 1.. _ _ I I II I I' I. l_- I 11 I _! I__ I l i .4_ I l i . 1 1 I _ I ' 11 I L I A IL_II ' 1 l i 1 1 i_ I I J.. I. _! 1 1 _:_ I i l, iI I 11 1 ' 1 1 [ 1 1 1 1 1 1 1 . 1 I I i I I� I 1 11_ 1II1 1I 1.f1 1 I! 1 I 1-1 I_ I) �. t 1 ■ I - L 11 I I 1 Site Plan submitted by: TITLE Page 2 of 3 I P I I- 1 1 L I I_ I_ I 11 I I 1 1 I . I JI I I I I , I_1!_I° I _ -_.J r I i I I I 1 ! .I I I( & 11 _ !III II I I i i 1 1 L -� I_ _ I 1 I -- 1 ! I 1 1 � I I 11 1 1 1 I 1 11 I , I 1 L I �_ , I 1 i l (I I l I I V I I Y`144-4-4r. I I I I I I H I I I. I i f I I I I I I I U I I I ' ��' -�j I�°'_���� £�r�",�� 1 I. - - II I III I I i . L l V I I I I !III 11 I I 11 __ I I I I_ 1 I. I I I . 414411 � _ I I- L LI � - I �� i� I I I J. I '1 I i ..__ I_ 1I I_l- 11 I._ i_ L 4 t < +! ± 1 i l �1 I_ I I I I I I I 1 - _I -I. I� _I - - -- 1 -._I l I l I I! L I I_ - - -I I L.- I I� 1 I Ili L I I I I 1 I (I I II i IL1 I I I II I I lI IIII 1 ) 1 !), Jr 11 I I i Notes LEVY` SE_ e 96/ ' q S1 TL- ET 50 36' 0q % 4L 4I T 01 - 0' Sys .r, avutzrtoo►NG. a. OPF �4. P F . . �. NOT / Q VA iLAe4t- 07- 0P01 PE: I i pctm : -7/3/q6 ys7r74 SI NATURE Plan Approved of Approved Date By ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744- 002 - 4015 -6) County Public Unit Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address __ ___ _ No.________ Street_ Registered Architect and /or Engineer_-__ Employing Plumber's Name Street Location and Legal Description Lot_ _ _ __ ^ Block __ __ Subdivision Street Street and Number where work is to be performed —No.__ � .�7 2 7 ___ State work to be performed and purpose of building (By Floors ) _ N B __ Remodeling____ _____ Addition Repairs No. of Stories. Size Septic Tank Feet of Drain Tile_____ Amount of Permit $_ t MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Nature of Water Supply: City — Well.-.-___._ ------- _ ------- ____________--- ___— ____Size of Soakage Pit Date /2 S.� ,JI e __Type of Tank Capacity Gals st. Feet of Tank or Drain Field from Well (Signed) _ Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has ccnn- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be erformed under this permit, as are licensed by Miami Shores Village. (Signed)- -- &I 77 Master Plumber. STATE OF FLORIDA, as. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or worlonanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' N5 TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address __ ___ _ No.________ Street_ Registered Architect and /or Engineer_-__ Employing Plumber's Name Street Location and Legal Description Lot_ _ _ __ ^ Block __ __ Subdivision Street Street and Number where work is to be performed —No.__ � .�7 2 7 ___ State work to be performed and purpose of building (By Floors ) _ N B __ Remodeling____ _____ Addition Repairs No. of Stories. Size Septic Tank Feet of Drain Tile_____ Amount of Permit $_ t MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Nature of Water Supply: City — Well.-.-___._ ------- _ ------- ____________--- ___— ____Size of Soakage Pit Date /2 S.� ,JI e __Type of Tank Capacity Gals st. Feet of Tank or Drain Field from Well (Signed) _ Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has ccnn- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be erformed under this permit, as are licensed by Miami Shores Village. (Signed)- -- &I 77 Master Plumber. STATE OF FLORIDA, as. COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or worlonanship. BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA ` 3— ELECTRICAL ❑ p Date I9 _,. PLUMBING C3' PERMIT N9 0104 Contractor's trip -2.7A 3 ROOFING ❑ License No ❑ Work to be performed under this Permit Owner of Building '{ L r; 1/ t t,. C` t.+ S "�� Architect 1 L` L �� r Contractor --- or Builder 0 ► _ - ' 1 , t:_- 17 r . 1 .r . i Oc> to D,_i ti, Legal Lot Subdi- Description M B1 vision Address of Sq Ft Building 1 (1 }. � 1 '-' i r V a l u e Project J $ 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 applica- tion 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 o drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. i Signed• / -,- 'G•°•••(INSPECTOR) BY In consideration of the issuance to me of this permit I agree • perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings Cements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work don - j. either, myself, my agent, servant or employee. 7 CONTRACTOR or BUILDER . II Amount of (4 / Jr Permit $ BY AUTHORITY