584 NE 102 St (6)3 i/a
ate / Job Address
.egal Description
)wner / Lessee / Tenant
+wner's Address
: ontracting
!ualifi
ate:
?ES: PERMIT
?PROVED:
a
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
'(d 7771-6 .01/05 0
Master Permit wes
5/ /IL (.(, ST Phone Jd.� 7J" - "22 ‘e'
t6..Y iv � /
Tax Folio /r--)a 676 -04? -/ 0 2 -/
Address c //a)
Phone .c 44 Xi
state If01aao Municipal # Competency !fr Ins.Co.
schitect /Engineer Address
conding Company Address
fortgagor Address
ermit Type(circle one): UILDING LEC :. AL PLUMBING MEC. CAL ROOF NG PAVING FENCE SIGN
ORK DESCRIPTION �j -' d•- r • �% � "" 0
4 quare Ft. Estimated Cost(value) / Pr
ARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND FAILURE TO DO
0 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
OTICE OF COMMENCEMENT).
pplication is hereby made to obtain a permit to do work and installation as indicated above, and
n the attached addendum (if applicable). I certify that all work will be performed to meet the
tandards of all laws regulating construction in this jurisdiction. I understand that separate
ermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
WNER'S AFFIDAVIT: I certify that all the foregoing information is ac <urate and that all work will
e done in compliance with all applicable laws regulating construction -nd zo ng. Furthermore, I
uthori
Z9 the 4ove -named contractor to do the work stated.
i
ig uure of owner aHd /o_ Conde, President
atary as" M W * .iM " :vim n
y Commission Expi,-s:
dent
My Commission Expi es:
Notary a � .� = �` -- = -- �....!
� lder
• * * * * * * * * * * * * * * * **
`
RADON C.C.F. f(0 NOTARY - TOTAL DUE e 6
Fire Other
Zoning Building Electrical
Mechanical Plumbing_ Engineering
!TEM
BATH TUB
UNIT
FEE
ITEM
SWITCH OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
UNIT
FEE
BIDET
LIGHT CUTLETS
CENTRAL HEATING
DISNHASHER
RECEPTACLES
A/C (}MIND)
0IS??OSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN A4PS
DUCT WORK
FLOOR CRAIN
SERVICE REPAIR/PETER Ct'A4GE
REFRIGERATION
GREASE TRAP
APPLIANCE CUTLETS
PRCCESS AND PRESS PIPING
INTERCEPTOR
RANGE TCP
UNDERGROUND TANKS
L AVATCRY ,
OVEN
ABOVE GROUND TANKS
LAUNDRY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MJTCRS 0- 1 HP
STEAM BOILERS
S-!0'i+ER
MOTORS OVER 1- 3 FP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTCRS OVER 3- 5 NP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 FP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MDTCRS OVER 8- 10 FP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MflTCRS OVER 10- 25 FP
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-1C0 HP
`
CCOLING TOWERS
'HATER CLOSET
MOTORS OVER 1C0 FP
_
VIOLATION
INDIRECT WASTES
F
A/C WINDOW
REINSPECTION
WATER SUPPLY T0:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
•
HEATER -NEW INST.
GENERATORS TRANSFORMERS
HEATER - REPLACE
GENERATORS TRANSFORMERS
LAIN SPRINKLER -WELL
SPECIAL PURPOSE
SWIWING POOL
CUTLETS COM4, RCIAL
WATER SERVICE
SIGN TUBES
;EWER CONNECTIONS
SIGN TRANSFORMERS
iTILITY -SEWER
SIGN TIME CLOCK
,—
rT I L I TY -WATER
FIXTURES
EPTIC TANK
ANTEKNA
ELAY
TELEVISION CUTLETS
RAINFIELO, 4 TILE/RES.
VIOLATION
Ulf S ABANDON SEPTIC TANK
RE I N'SPE, ION , /
i y
0IXAGE PIT CU. FT.
ATCH BASIN
---
ISCHARGE WELL
� liliJ �. /7
J
h20/e4. -
.
OMESTIC WELL
REA [MAIN
0F INLET
OLAR WATER HEATER
IRE STANSPIPE
Xl PIPING
kWN SPRINKLER SYSTEM
LS RANGE
:TER SET (GAS)
LS PIPING
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
03TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ELECTRICAL
MECHANICAL