1431 NE 101 St (4)1
Date 6" /S Q8 Job Address /43/ ME /0/ Tax Folio
Legal Description
Owner / Leese& / &mutt- S y/3/ L OA,P
Owner's Address 431 NE /O/ Si
Contracting Co. 4L[.. 7f9 5; / = 7 -- ,e /C
Qualifier 9!ANI K fk EC1�U,� ss# Phone 30S - 754 -575
State # Municipal # Competency # 432-135 Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 2-00A IeV I C C ( ci 'tsE ) - r - Di' I O (Al/ Ac. St jS ,
Square Ft. Estimated Cost(valu0000.
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).
C V .:)
Application is hereby made to obtain a permit to do worf 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 � o ing. Furthermore, I
authorize the above -named contractor to do the work stated. xaeedg
Sign
Dat
otary as to
02.4- uh �
r
My Comm' sio Expires:
** * * *
FEES: PERMI
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
a n d President Signature of Contracto or Owner- Builder
62 0- -- /e -7d:V ? Da : 06// 991
GLADYS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COM ISSIO EXP. M 1,2002
Zoning
Mechanical Plumbing_
Address 055 /\l. 0,71 S+.
Notar as to Contractor or Owner- Builder
My mmi s s i on Exp i r : "4 �, Verona c gaumstark
0
* My Commission CC610722
o; Rolm March 15, 2001
* * **
Og
TOTAL DUE /or
NOTARY
Master Permit IJ :39
')
Building Electrical
Aga" 757- 4-&4
Fire Other
Engineering
ITEM
BATH TU3
UNIT
FEE
ITEM
SNITCH CURETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
810E7
LIGHT CUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND)
DISMAL
` SERVICE TE141PORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS 2.l9U
/
3,�
01CT 110RK
FLOOR DRAIN
SERVICE REPAIR/bETER OWE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS ANO PRESS. PIPING
INTERCEPTOR
RANGE TOP
UOERGROUNO TANKS
LAVATORY
.
,
OVEN
ABOVE MOW TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER 80ILERS
SINK, POT /3 COMP.
^ % OTCRS OVER 3- 5 If
MECHANICAL VENTILATION
SINK, RESIDENCE
MQTCRS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
S1HK. SLOP
MOTCRS 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
WINOOPI
REINSPECTION
WATER SLPPLY TO:
,
AIR CONDITIONERS }-MA-
,r
40
'
A/C UNIT
STRIP HEATER
r
4
,
FIRE SPRINKLER
GENERATORS TRANRS
'
HEATER -NEW INST.
GENERATORS TRAR3FOi6ERS
HEATER - REPLACE
GENERATORS TRAISFORERS
LAWN SPRINKLER -WELL
SPECIAL PUPPOSE
SWIMMING POOL
CUTLETS COMfEACIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY-SEER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TAN(
ANTENNA
RELAY
TELEVISION OUTLETS
GRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REIISPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
01SCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANT THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL