EL-05-346Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING REGENEDPermit Naz -'E1 -.C75
PERMIT APPLICATION OC r2905Aaser Permit No.
FBC 2001
Permit Type (circle): Building Electrical-� Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) tlG ��� G Phone it 77-3 ;?� 2
Owner's Address /%�
City/�ii &''`'i _State C . Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City
Qualifier.
State Certificate or Registration No.
Phone #
State Zip
Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit *10M
Type of Work:
Describe Work:
❑Alterat��New
Square Footage Of Work:
❑ Repair9keplace ❑ Demolition
Submittal Fee $ Permit Fee $ M� r tvo CCF $ GC7 CO/CC.
Notary $ J ! C)z) Training/Education Fee $ .0,2-0- Technology Fee $ 3. 15
Scanning $3 - co Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $ bZ
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved a� einspection fee will be charged.
7 Signature Signature
er or Agent Contractor
The for mg mstrumenrt was acknupwledged before)methis The foregoing instrument was acknowledged before me this
day o4,20wa�y ` V , C=r� day of _ , 20 __, by
who is personally known to me or who has produced who is personally known to me or who has produced
I%--- .41%
My
As identification and who did take an oath. as identification and who did take an oath.
•----------
NOTARY PUBLIC:
1
Sign:
My Commission Expires:
APPLICATION APPROVED BY.
Plans Examiner
Engineer
chc 05113/03
Zoning
ADDENDUM TO BUILDING PERMIT APPLICATION
'(AN A£PLICATION 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
ITEM
BATH TLB
UNIT FEE ITEM
SWITCH OUTLETS
UNIT FEE ITEV MIT FEE
SPACE HEATERS
BIDET
LIGHT OUTLETS
CENTRAL HEATING
DISHWASHER
RECEPTACLES
A/C (WINO)
DISPOSAL
SERVICE TEWORARY
AIC (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
SERVICE REPAIR/METER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
OVEN
ABOVE GROl1N0 TANKS
LAUNORY TRAY
WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS D- 1 If
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
NOT WATER BOILERS
SINK, POT/3 COM?.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK, RESIDENCE
MOTORS OVER 5- 8 HP
TRANSPORTING ASSMLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
FIRE SPRINKLER SYSTEMS
L&RIHAL
MOTORS OVER 25-100 If
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION {
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
{
HEATER -NEW INST.
GENERATORS' TRANSFORMERS
{
HEATER -REPLACE
GENERATORS TRANSFORMERS
LAWN SPRINKLER -WELL
SPECIAL PWOSE
SWIMMING POOL
OUTLETS COMMERCIAL
WATER SERV ICE
S I GN TUBES
SEWER CONNECTIONS
PSIGN TRANSFaWERS
UTILITY -SEWER
SIGN TIME CLOCK
UT IL ITY-WATER
F IXTRI:RES
SEPTIC TANK
ANTENNA
RELAY
TELEVISION OUTLETS
GRAINFIELD, 4' TILEAES.
VIOLATION
PU6P & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA MAIN
ROOF INLET
SOLAR WATER HEATER
{
{
FIRE STAND IPE
POOL PIPING
LAWN SPRINKLER SYSTEW.
{ {
GAS RANGE
METER SET (GAS)
w PIPIk
E i
e I ► I