EL-03-263 Miami Shores Village
Building Department
artment
10050 N.E.2nd Avenue
Miami Shores,Florida 33138
Tel:(305)795.2204
IRECEWED
0 2 2003 Fax:(305)756.8972
BUn�DING m__o m___-- Permit No. F 1 x-003 .
PERMIT APPLICATION Master Permit No.
FBC 2001
Permit Type(circle): Buildin Electric `Plumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder) ( I Phone-m �0) -7 �-q- D o J^I
Owner's AddresslS ff 4,
City 1G9AMn' SI-695 State Zip �3
Tenant/Lessee Name Phone#
® Job Address(where the work is being done) 1 v o
City Miami Shores Village County Mi i-Dade Zip
h Building Historically Designated YES NO
' 11
Contractor's Company Name �Q IL e� l r N / L Phone#
Contractor's Address
City State Zip
Qualifier
Architect/Engineer's Name(if applicable) - Phone#
Architect/Engineer's Address
City State Zip
$Value of Work For this Permit_ Square Footage Of Work:
Number of.-Bays Stories Families Bedrooms Baths
Type of Work: []Addition []Alteration []New ❑ Repair/Replace ❑Demolition
e Describe Work: L a991 -DaZi& Ll Gs 1'14 iLaA&4- r®0i .64 0Z 2 Rke ® r�
Kr-
/*,�*,�*��r**,r***�****,��•,.*f*,��,�Fees,r�r,�,�,r,�,�,r,�,r�t**,�,r****,�,r,�,r,.�*a**
County Escrow Fee$ Oy Permit Fee$ Notary$ 5-GoEducation/Training Fee$ Tech$ Scanning$ Radon$
Code Enforcement$ Bond$ Stru�$
Minus Plans Cbeck Fee S Total Fee Now Due$ i (Continued on opposite side)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 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 s en (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a i pection fee will be charged.
�i Signature AZA ®Si
gnature ��
ym.- St
er o A ent 44 Contractor
The fore oingas acknowled ed before me this L� Ig The foregoing instrument was acknowledged before me thisday of bynOF
day of + 206J by l o 0 n n,
.who is pe nally known to me r who has produce lj who is personally known to me or LM.produced
As identification and who did take an oath as identification and who did take an oath.
NOT Y as
P �L C• ,.�0"'P�e. Mabel Vargas?=NOTARY PUBLI '"""'
Sign: -
Co on#DD231984' '� Mabel �
'a Sign:. "' ° ._- is i
Print: ' oc Rnn lA+ n.'. .
Print: °` Jul 3,2007
My Commission Expires: 14
onding Co.,Inc.
Mabel Var My Commission Expires:
�,,�•Y P 9 0' t',
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_CX. Expires:J SQA of Competency Holder)
9,'�`OF i+c?�` Bond
011110 AUandc Bonding Co.,
State Certificate or Registration No. Inc.
Certificate of Competency No.
, c
APPLICATION APPROVED BY Plans
Examiner
Engineer
chc7nios
Zoning
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN f2PLICATION 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 UNIT FEE ITEM UNIT FEE ITEM UNIT FEE
BATH TUB SWITCH OUTLETS SPACE HEATERS
BIDET LIGHT OUTLETS CENTRAL HEATING
DISHWASHER RECEPTACLES A/C (WIND)
DISPOSAL SERVICE TEMPORARY A/C (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 GROUND TANKS
LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS
CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS
SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS
SINK, POT/3 CAMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION
SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES
SINK, SLOP MOTORS OVER B- 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 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 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
DRAINFIELD, 4' TILE/RES. VIOLATION
PUMP S ABANDON SEPTIC TANK REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INET
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING