1177 NE 91 Terr• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date .S Job Address (177 &/ E 'Jf 7E72,q Tax Folio
Leal Descri lion - ( zESS
Legal p C 1 d E5 fq y / � - Ii storically Designated: Yes No
p L d" . � .2-. f� Wei /S' D f /-o7`E ) 3
Owner/Lessee / Tenant J'' / �� G. $ Master Permit #
Own js i�s /C7 7 /V E �f 7 R /'� 5Iiores Phone 757-33,72 7
Contracting C o. P 0. ;J ! D 5el Address
Qllalifier 4f redo Vey (51
State # (3 G /47°,7 Municipal # le l –. Competency # E / cI y g Ins. Co.
Square Ft. I `) 3,). S 9
laws regulating constru
� in r
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Signature of owner and/or Condo ' esident Date`
Notary to Owner and/or Condo President
My Commission Expires:
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f
FEES: PERMIT 3-2, _co RADON
APPROVED:
Zoning
Mechanical
C.C.F.
SS#
Estimated Cost (value) T O 1l O D d
n and zoning. Furthermore, I authorize the above- nam7Qyontractor to do i e work stated.
Signature of ntractor or •wner- ilder
00
NOTARY
Mii ,z_ 33/
Phone cR 4 -' c9-o°9-9
Architect/Engineer .Nfr Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 5171 �l P : cy e ' e V E 1.0A/ RiVc/ 4 pI019-a
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 PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN 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 construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
AAA 04Aifij
Notary as to Contractor or Owner - Builder
My Commission Expires:
TOTAL DUE
Date
' Date
39. -ry
Building gAit ' \ Electrical
Plumbing Engineering
Habe. Devin
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N O T I C E O F C O M M E N C E M E N T it
(Prepare in Duplicate) a
To Whom It May Concern: 0
0.
.~
THE UNDERSIGNED hereby gives notice that improvement will be made
to certain real property, and in accordance with Chapter 713, ri
Florida Statutes, the following information is provided in the (e)
NOTICE OF CQMMENCEMENT. 1J1
Description of Property: /ot4/ L655 f//E W6 1 /0 1 / 7 66t/9/ 1 - ,4
OC I - „ - f a . a ' I l k . W s rLy /s f 6 E t pp 4 o 7 , • RA - O C / a Pe mit Number: Folio Number: 1 I - 3?. 05 -- 00 l -0 I9 0 u?
fA
General description of improvement: ,f /mp6C! co vci2E
1) R ! 116 vtl4 V AN S 1107204c%rr
This document / /was prepay by:
Owner:
Address: /) •i7 l/ 762/2/} m / SgeeE.S Fi 23108
Owner's interest in site of the improvement:
Fee Simple Title Holder (if other than owner)
Name:
Address:
Contractor:
Address:
Surety (if any):
Address: Amount of Bond: $
Name of person within the State of Florida designated by Owner
upon whom notices or other documents may be served as provided by
Section 713.13 (1) (a) 7., Florida Statutes.
Name:
Address:
In addition to himself, Owner designates the following person to
receive a copy of the Lienor's Notice as provided in Section
713.13 (1) (b), Florida Statutes.
Address: tirAd Name:
Expiration date: 1•11/Or/i'if!llf/:�i�'�i���
`� ” • ner
Sworn to and subscribed fore
me this . // day of ,Q , R Ian ,
199 Fc .
/14821 ,D6sffAA
StA32 / e2 EfE N.
- 7353 ) t d 717//1)77/ 11 33 j a-
STATE OF FLORIDA, COUNT' 0. DADE
HEREBY CERT that I •is is a f r so py of the
original
a . O vial
, A 0 19
WETNESS my hand
HARVEY RUVIN E'
ool.
O IUAL tk f AKY SEA S, ,..._
t L i DA FF.flNANDF.Z
_ • STATE Ut FI.OF:f[
Notary Pub is ±7AMISSOt NO. CC3 566.!
MY COMMIFSON F.XP,.MAY 1119'
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