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269 NE 100 St (10)Date .7 /v7 7 Job Address ??69 N , E . /0 ©S • Tax Folio Legal Description Historically Designated: Yes No / Tenant _/ Cott- "- D 1A ( ) c } Master Permit # Owner's Address c r ) 09 s* Contracting Co. E 1 - Cp l G , Qualifier �a 1 2 • M ad s-en State # > :C 9d 0 /° Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDIN EL WORK DESCRIPTION _ S /66Act aiui Notary as to Own er and/or Condo My Commiss I S: PERMIT 3® "�® RADON APPROVED: Zoning Mechanical PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Municipal # / / / r CAL _C0S Si . ature of owner and/or Condo President ate R' Vtri3 OFFICIAL NOTARY SEAL e �i BARBARA ANN FUGAZZI > � COMMISSION NUMBER � ( CC360191 S' . le MY COMMISSION EXP. OP p4b AR. 9 1998 .... n t Phone 754 % l ?' I (3 /li''c oast SS# hone L97 43 73 May)ad 66/A4 Address Competency # Address Address C.C.F. NOTARY S. oa Ins. Co. UMBING MECHANICAL ROOFING PAVING FENCE SIGN "CC- r ( C t� 1/1/ °� e i ► 0L4 -e r ►1 t. v✓ 10 £ v_1 Y . Square Ft. Estimated Cost (value) ) 00 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 construion and zoning Furthermore, I authorize the above -n. .ntractor to do the work stated. Signature of Contractor or Owner- Builder XStihAet altAl Notary as to Contractor or Owner -B My Commission Ex p• PC/6. OFFICIAL NOTARY SEAL 0 1P e(. BARBARA ANN FUGAZZI * ' � % COMMISSION NUMBER ) ''IU' CC360191 MY COMMISSION EXP. F OF FN. M AR ; 29,109 8 TOTAL DUE 5/(619.5 Date Co Building Electric Plumbing Engineering (AN APPLICATION FOR BUILDING PERMIT RUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) UNIT FEE ITEM SWITCH OUTLETS LIGHT OUTLETS RECEPTACLES SERVICE TEMPORARY SERVICE SIZE IN MPS SERVICE REPAIR/METER CHANGE APPLIANCE OUTLETS RANGE TOP OVEN WATER HEATER MOTORS 0- 1 HP MOTORS OVER 1- 3 HP MOTORS OVER 3- 5 HP MOTORS OVER 5- 8 HP MOTORS OVER 8- 10 HP MOTORS OVER 10- 25 HP MOTORS OVER 25-100 FP MOTORS OVER 100 HP A/C WINDOW AIR CONDITIONERS STRIP HEATER GENERATORS TRANSFORMERS GENERATORS TRANSFORMERS GENERATORS TRANSFORMERS SPECIAL PURPOSE OUTLETS COMAERCIAL SIGN TUBES SIGN TRANSFORMERS SIGN TIME CLOCK FIXTURES ANTENNA TELEVISION OUTLETS VIOLATION RE INSPECTION UNIT 3 6 FEE ITEM SPACE HEATERS UNIT CENTRAL HEATING A/C (WIND) A/C (CENTRAL) DUCT WORK REFRIGERATION PROCESS AND PRESS PIPING UNDERGROUND TANKS ABOVE GROUND TANKS U.F. PRESSURE VESSELS STEAM BOILERS HOT WATER BOILERS MECHANICAL VENTILATION TRANSPORTING ASSEM3LIES ELEVATORS/ESCALATORS FIRE SPRINKLER SYSTEMS COOLING TOWERS VIOLATION RE INSPECT ION FEE I TEM PLUMBING BATH TUB 8 IOET DISHWASHER D ISPOSAL DR INK IIG FOUNTAIN FLOOR DRAIN GREASE TRAP INTERCEPTOR LAVATORY LAUNDRY TRAY CLOTHES WASHER SHOWER SINK, POT /3 COMP. SINK, RESIDENCE SINK, SLOP TEMPORARY WATER CLOSET URINAL WATER CLOSET INDIRECT WASTES WATER SIFPIY TO: A/C UNIT FIRE SPRINKLER HEATER -NEW INST HEATER - REPLACE LAWN SPR INKLER-WELL SW I M11I NG POOL WATER SERVICE SEWER CONNECTIONS UTILITY -SEWER UTILITY -WATER SEPTIC TANK :ELAY GRAINFIELD, 4 TILE/RES. UMP 3 ABANDON SEPTIC TANK .10AKAGE PIT CU. FT. :ATCN BASIN DISCHARGE WELL DOMESTIC WELL -AEA GRA ;00F INLET iJLAR WATER HEATER IRE STA IJPIPE 00L PIPING AWN SPRINKLER SYSTEM AS RA/43E _TER SET (GAS) AS PIPING `ADDENDUM TO BUILDING PERMIT. APPLICATION ELECTRICAL MECHANICAL