1411 NE 101 St (12)Date Job Address /179/ Yu e /0 / 5 / Tax Folio
Legal Description Historically Designated: Yes -7 No
Owner/Lessee / Tenant /4 I?tvo L b f37 13 ( Master Permit # r /i / STS
Owner's Address 1 1111 NC- 101 S I Phone 7 — 6776
Contracting Co. CCArn FO2TZ r'o p ,4/C Address Z. 12-o S uo O 2 A 1'°
Qualifier M 1 (I t)E L Q"' Cfl t 3 ss# Phone 2Cc( -- 51
State # Cry CO S6,9SS Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING C I ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A% uA 1 Qicepit, CIV
Square Ft. Estimated Cost (value) 3- • BD
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
constru on and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
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er and/or C
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O F1 . N• RYS
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CO. -) 10. CC71
•
COM A1SS1Ord EXP. MAR. 1,2002
Signature
Notary as to Owner an
My Commission Expir
Co
FEES: PERMIT
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
es-
RADON
0
ndo President Date
X0
ed
Zoning Building Electrical
ntractor or Owner- Builder
tary as to Contr
My Commission
C.C.F. O\` tip NOTARY BOND
TOTAL DUE
ate
Date
Oa
Mechanical 1 7 y Plumbing Structural Engineer
ITEM
BATH TU3
UNIT
•
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT CURETS
CENTRAL HEATING /
D ISI-MASHER
RECEPTACLES
A/C (WIND)
0IS?OSAL
SERVICE TEMPORARY
A/C (CENTRAL) SIDO
DRINKING FOUNTAIN -
SERVICE SIZE IN AMPS
DUCT WORK'
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
2REASE 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
}TORS 0- 1 HP
STEAM BOILERS
SHOWER
}TORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
}TORS OVER 3- 5 If
MECHANICAL VENTILATION
SINK, RESIDENCE
}TORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK. SLOP
}TORS OVER 8- 10 FP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
}TORS OVER 10- 25 FP
FIRE SPRINKLER SYSTEMS
'RIND
}TCRS OVER 25-100 FP
COOLING TOWERS
1ATER CLOSET
}TORS OVER 100 FP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
9ATER SUPPLY TO:
AIR CONDITIONERS
•
A/C UNIT
STRIP HEATER
FIRE SPRINK
GENERATORS TRANSFORMERS
'
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMIING POOL
OUTLETS COMMERCIAL
WATER SERVICE
SIGN TUBES
EWER CONNECTIONS
SIGN TRANSFORMERS
TILITY -SEWER
SIGN TIME CLOCK
TILITY -WATER
FIXTLRES
EPTIC TANK
ANTENNA
FLAY
TELEVISION CUTLETS
ZAINFIELO, 4' TILE/RES...
VIOLATION
_,
W & ABANDON SEPTIC TANK
REINSPECTION ,---,
`
JAKAGE PIT CU. FT.
JOH BASIN
ISCHARGE WELL
:MESTIC WELL
IEA (MAIN
;OF INLET
;LAR WATER HEATER
RE STANDPIPE
,
AL PIPING
.
, RN SPRINKLER SYSTEM
S RANGE
TER SET (GAS)
S PIPING
(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
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
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