287 NE 101 St (12)Date /02 ` 41 '1 Job Address � AO/ Tax Folio
Legal Description
Owner/Lessee / Tenant y� �Q Master Permit #
Owner's Address • ?2 `� 4 70/ �` , Phone
Contracting Co. ` 2 0 /2 " / 4l c CO /°, Address / 9��5 .7 /4 0 "S J.
Qualifier / / /0 7 C) Z , ss# -?,53 = J' 97 '
State # 2 f oa / Cp Municipal # a - C S c5 J Competency # //- 4 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
RADON
WORK DESCRIPTION Vce r e
Historically Designated: Yes No
Square Ft. Estimated Cost (value) 2 Sid
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.
Signa �, of Contractor or Owner -Bu'ld
otary as to Con : ctor or Owner- Builder
My Commission Ex
LISETTE MARIA GARRIDO
My Conan Exp. 900/98
Banded By Service ins
1•10. COMA?)
$inne i View 1 DD
{�
C.C.F. /� NOTARY / TOTAL DUE ) ! 3't
Date
Date
APPROVED:
Zoning Building i Electrical
Mechanical Plumbing� 91 Engineering
ITEM
BATH TB
UNIT
2
FEE
tip
ITEM
SWITCH OUT[.ET'S
UNIT
FEE
ITEM
SPACE !EATERS
UNIT
FE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
/
J2
RECEPTACLES
A/C (WINO)
OISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
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
UNDERCROUN) TANKS
LAVATORY
.5
OVER
ABOVE MOM TANKS
TRAY
7 5,&
MATER HEATER
U.F. PRESSLRE VESSELS
CLOTHES WASHER
/
)ie
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
/
f
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT/3 COMP.
MOTORS OVER 3- 5 HIP
MECHANICAL VENTILATION
SINK, RESIDENCE
/
J1,
MOTORS OVER 5- 8 Hp
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEYATORS/ESC.UTCRS
TEWORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
2 J
MOTORS OVER 100 Hp
VIOLATION
ITOIRECT WASTES
A/C WINDOW
REINSPECTION
WATER St.PPLY TO:
AIR CONDITIONERS
•
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER - NEW INST.
/
J,J
GENERATORS TRAIGF( ERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PUIPOSE
SWIMMING POOL
OUTLETS COMERCIAL
WATER SERVICE
/
?
SIGN TLBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY-WATER
F IXTLRES
SEPTIC TANK
AMA
�--'—
RELAY
TELEVISION OUTLETS
DRAINFIELD. 4' TILE/RES.
VIOLATION
PULP & ABANDON SEPTIC TAN(
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
^--�--
OISCHARGE WELL
«--^
DOMESTIC WELL
AREA DRAIN
ROOF INLET
�'—
` LAR WATER HEATER
IRE STANCPIPE
'COL PIPING
.AWN SPRINKLER SYSTEM
AS RANGE
,'TER SET (GAS)
'S PIPING
•
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL