EL2003-310 PERNIIT"PLICATION ON
FOR XHANH SHORES VILLAGE
10050 N.E.2nd Avenue•Miami Shores,Florida3138•Phone:305-795-2204• Fax:305-756.8972
Date Job Address 1Z=r 3 A4G• 1A-3 ArTax Folio
Legal Description Hisi oricAy Designated: Yes No
Owner/Lessee/Tenet ®1G�t� /F' .���� Master Permit# RoO/ ,4�3— !s 91
_ a tL 03 - 3 1D
Owner's Address Z/7 3 &C' /d—T 57 Phone
Contracting Co. �" /�.G- tel!� +�°t C• Address ! � �✓ /1°�' �`� S�
Qualifier ��tJ/ /t. .�PCy! SSS# Phone `?YY—�677 J
State# Municipal# Competency# his.Co.
ON THE JOB SITE FOR INSPECTORS TO VERIFY
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ,
THERE WILL BE NO INSPEC'T'ION.RE-INSPECTION FEE IS$50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION: ZzA, , ®7" ;3� 1�e, T`!-®® A,—Z4=65,
Square Ft. Est mated Cost(value)
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 PROPE TY(IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH
YOUR LENDER OR ANY 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 constriction in this jurisdiction.I understand that separate permits are required
for all disciplines.
OWNERS AFFiDAVrr: 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.
Sitatud of owner and/or Condo President Date Signature of Contractor or Owner Builder
NANCY R. fACERLEAN ^?
' Notary Put-TIC-Stat®of Ftp d 0
Notary as to Owner and/or Condo President Date Notary as oHW294047 ate
My Commission Expires My Co s a seanew 13YRatlonet MWD
AsagAw
n.
FEES:PERMIT OW or mp RADON C.C.F NOTARY BOND—
JA-9%A-
OND
JA-9%A-� TOTALDUE USC- •a ,�.c�/I� 'Z,s ANd 0 9 1
APPROVED: 03, 3 D
Zoning Building Electrical f<dzdfe� d°
Mechanical Plumbing Structural Engineer
NIIANII SHORES VILLAGE
BUILDING DEPARTMENT
305-795-2204
Building Inspection Requ st
Date t"� Time
Type Insp'n
Permit NF Z 0-31 31 D
Name _;
Address C
Company
Phone# 30s - SV- 91 A
For Inspector: ��l Fame 8-1
Approved
Correction ❑ ��/ � �
Re-Insp'n Fee ❑