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PL-05-89 1Vildlill ►311ul GN v lllagc Buildin Department r`' # 1005 mi Shores,Florida 33138 l�? 795". 204 F x: (305)756.8972 BUILDING �;�.� 1 �' �ont .,,4 Permit No. PERMIT APPLICAT = p Master Permit No. FBC 200 Permit Type (circle): Building Electricaly PlumbiGn1g Mechanical Roofing Owner's Name(Fee Simple Titleholder) 4d11 F)a N`� ` �ff A Phone# (��) RII-07 - Owner's AddressAl—C, LQ 6/ . City M. S� State Zip J Tenant/Lessee Name Phone# Job Address (where the work is being done) � / � f"—/ * /0 City Miami Shores Village County Miami-Dade Zip 3 is l<uilding Historically Designated YES NO_ �C_ Contractor's Company Name Phone# Contractor's Address �- f City State Zip Qualifier State Certificate or Registration No. Certificate of Competency No. g P c3' Arebitect/Engineer's Name(if applicable) Phone# S Value of Work For this Permit I D� r Square Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New �Repai(/Replaze) El Demolition Describe Work: Hi\:T h ///TI1�� J lcL/ f T Submittal Fee Permit Fee r _ CCF S MCC Notary S Training/Education Fee S Technology Fee S Scanning S Radon S Zoniffly Bond C;ode.Lifforeement S Structural Plan Review. S I otsft Fee None Dw" IS ?'; =Rrariarrs,,,, rri� otancrso:f, situ. Bonding Company's Name(if applicable) Bonding Company's Address City State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address Cit, 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 seven (7) days after the building permit is issued In the absence of such posted notice, the inspection740pprove,,andrrjonfiee will be charged. Signature Signature Jai er or Agent Contractor The foreg0ji.1g instrunient was acknowledged before me this { The foregoing instrument was acknowledged before me this day of � 20 by ` ,', j day of 20_,by who is personally known to me or who has,produced who is personally known to me or who has produced . NotAq;,-, As identificatitj2i a c to did take an oath. as identification and who did take an oath. C "1 OTARY PUBLIC: NOTARY P LICA: oR o N Sign: j ' _ .oi Sign: Print: Print: My Commission Expires: �a'h '� o®�� My Commission Expires: kit*9:k�:k ic:t at�:Y k kith**.*k:t**�****ot**�yFie#- **3c k is k�c#x�,k**ick*t9:ic*:k9:�c 4 tkk*txi:*at ie t*k9e:t':Y:�9e*kk*Ek9c*k**Yc�*9c*kit*k*`;Xk':sic;t *�%k*k%kk�%kkkkk-kkk%k%k%kk%kkkKk*'F*k%kkkk%k* ** kk kk kkk*k**kkkkkF�*k*:kkkk%kFkkkkkl-*k*/*f'{K*kkk **%kkhF*%kk%R*%k%k APPLICATION APPROVED BY: �� Plans Examiner Engineer Zoning Cho 05/13/02 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 ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES I A/C (WINO) 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 MOUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS O- 1 FP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT/3 COM?. 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 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 COW ERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY-SEWER SIGN TIME CLOCK UTILITY-WATER FIXTURES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4" TILEAES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION 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 PIPI%