825 NE 100 St (2)Date
** *
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address b 2- N /().0 S Tax Folio
Legal Description 1 I /
Owner / Lessee / Tenant i \ , a m `. C vLcn �S �� ��b Master Permit # 3‘Z
Owner's Address 1 k) 6 10 0 S 4 Phone
Contracting Co.� 0.... . % hbee-ScRlur -L Address 9t t( CO 0. r (D C
Qualifie;1) Q,v�v�,S `'Lo..������. SS#_ - 0 9 q9 3 Phone 7 S ((y �o
State # \�
Municipal # Competency #(A -0182 Ins.Co. LV \ �•wr`
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION �� O 'K V b L o_'J . (.,) e
CIOSel a
Square Ft. Estimated Cost(value) S-5-
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 do e in complianc; h all applicable laws regulatin: struction and zoning. Furthermore, I
auth ze the abov- 1 =me• contractor to do the work s
J dL1 L44
�'
Sign= re o
Date
Notary as to
My Commission
or Condo Presidentrr6v4A/r (
Date:
10Q ,�'•, a nt
rs .EYGIAES JAN 22,1998
BONDED THRU
I tOf PP" ATLANTIC BONDING CO., INC.
*
otar
My Comm
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FEES: PERMIT 3rOQ RADON C.C.F. NOTARY
APPROVED: Fire Other
Zoning Buildin
Mechanical Plumbing' - �"r� (/ ' � 1
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*
Ejp1,5 Aug. 16. 1997
Bonded by. HAI
800.422 -1555
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*
er- Builder
• ..•t.
,D, •. • - Builder
**
TOTAL DUE , Cf)
Electrical
Permit No.__/
Amount of Permit $
Application is hereby made for the approval of the detailed statement. of the plan's 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_ -- _--- .--- 'Pera No._ / ° � . •_ Street.
Registered Architect and /or
Employing Plumber's Name
Street
Location and. Legal Descript} Lot_____— ..... Subdivision __._..._
Street and Number where work is to be performed —No � «o - Jr Street -+ '
State work to be performed and purpose of building (By Floors)__.
Remodeling Addition._ - __. —•- Repairs No. of Stories......_..._.._... - ---
Size Septic Tank
Feet of Drain Tile
Nature of Water Su
STATE OF FLORIDA, !
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_- .------ -.Type of Tank__ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
-Size of Soakage Pit
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 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
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 performed under this permit, as are
licensed by Miami Shores Village.
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
(Signed)
Date
(Signed) - - -- ---° -- _ —
-1 /
Notary Public, State of Florida
Master Plumber.
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 workmanship.
CLO9ET6
BATH•
. TUBS
SHOWERS
LAVA•
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH.
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL.
FIXTURE6
CONTR.
LIST
Y
• Y
..----1-
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN.
FIELD
SOAKAGE
P1T
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SW IM'G
. POOL
.
CONTR.
/
~ --
CHECK
Permit No.__/
Amount of Permit $
Application is hereby made for the approval of the detailed statement. of the plan's 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_ -- _--- .--- 'Pera No._ / ° � . •_ Street.
Registered Architect and /or
Employing Plumber's Name
Street
Location and. Legal Descript} Lot_____— ..... Subdivision __._..._
Street and Number where work is to be performed —No � «o - Jr Street -+ '
State work to be performed and purpose of building (By Floors)__.
Remodeling Addition._ - __. —•- Repairs No. of Stories......_..._.._... - ---
Size Septic Tank
Feet of Drain Tile
Nature of Water Su
STATE OF FLORIDA, !
COUNTY OF DADE.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
_- .------ -.Type of Tank__ Capacity Gals
_Dist. Feet of Tank or Drain Field from Well
-Size of Soakage Pit
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 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
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 performed under this permit, as are
licensed by Miami Shores Village.
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
(Signed)
Date
(Signed) - - -- ---° -- _ —
-1 /
Notary Public, State of Florida
Master Plumber.
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 workmanship.
,