1230 NE 102 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ) ;V? i Job Address 17.3 0 1J l% ! oz. Tax Folio
Legal option l Qt 2. — 134 le_ IFS y r- eQ.Ziliistoricall Designated: Yes No
Owner/Lessee / Tenant Re_ _ 4' hies W 0 9 'e;4-ele.. Master Permit #
_
Owner's Address j2 i � l % 1 0 2S R f7 C& c vt'ldd Phone (3o) 7S - '`j 7- ` � ' Contracting Co. //j/l� a�'11: G g' 2 P Address s 72 7'1 L` 42 Si Fr. 2 o ue• 3 333 )t.
Qualifier I lca.'e/O dri 2 SS# /, Phone 3bc "7 - �Z✓rS'
State # C 19 CO z y 3 2_ Municipal # Competency # Ins. Co.
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICAL ROOFING / PAVING FENCE SIGN
19 o val d YI e°
WORK DESCRIPTION Fovy4% SuPO>y tilt - Ji-oP'
0 /A 1 D '"/ e4 f ».eJ b- a c .
X r
S ignature of owner and/or C do President Date
Notary as to Owner and/or Condo resident Date
My Commission Expires:
FEES: PERMIT 3 r �RADON
APPROVED:
Address
Me
Square Ft. Estimated Cost (value)
C.C.F. ) NOTARY
4
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.
Signature of C Owner-Builder
Date
Not: to Contractor or
My Commission Expi
ontr • • • or
f
6Z' 7% o--3
1
//
Electrical
3 9 Z 493 99�
OFFICIAL NOTARY SEAL
GLADYS) VILLAR
NOTARY PUBLIC STATE OFF{ *ID
COMMISSION NO. CC714103
MY COMMISSION EXP. MALI,2
BOND
Date
TOTAL DUE
Plumbing Engineering
/z. Ave,
/ 9,coly //v
Prudential -Bache Securities Inc., 2660 East Sunrise Boulevard, Fort Lauderdale, FL 33304 Tel. 305 564 -7681
Securities
ITEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
I '1
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WIND) '
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL) 5X /Sbh''
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT K g41.1 d,v p 3 '
I
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 IP
STEAM BOILERS
SHOWER
MOTCRS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS 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
A/C WINDOW
RE INSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
•
A/C UNIT
STRIP HEATER
Pia Pi e,c /2f .z-
1
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER-REPLACE
-
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERVICE
•
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
UTILITY-SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
GRAINFIELD. 4' TILE/RES.
VIOLATION
PUMP E ABANDON SEPTIC TANK
REINSPECT ION
SOAKAGE PIT CU. FT.
..
CATCH BASIN
DISCHARGE 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 ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL