1241 NE 91 Terr (11)Date 1 P . L i i c 1 Job Address ( 4 I /)It 9 1 ' t Tax Folio
Legal Description T F L / / 5' C P Lc-r i 01" 30/i Let 31 11.-SS THE 4,4STEWIY 35' TN-oeI Of
Owner / Lessee / Tenant C/T itisio'hhl_ bath-IT
Owner's Address
Contractin I Co. L{ , 5. 0 a. LLO SyS 5 /A)c- Address ”./ N. STF}E VZ-44741704 F1,3317
Qualifier ,../ A1-M s Obaa
State # 091) Municipal #
Architect/Engineer
Bonding Company
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN A)5
WORK DESCRIPTION I 82i 4( M-oGes Aar �letd4-Ylt0 iO4-y� ,4e _ / 4 4 -16
e � - Square Ft. •
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.
be done in compliance
auth +rx. , e abo -nam
Sign
Date:
** *
FEES: PERMIT 9'0
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
0-4 I �l 1 - f �lrvt! �� / 3� 3c �575 / -c
Address
y Address
I certify that all the foregoing information is accurate and that all work will
ith all applicable laws regulating construction and zonings Furthermore, I
con ;i tor to do the work stated.
President
Owner and /or prsiden t -
ssion Expires: z o *; ^r,iviir 'r CC 739016
r x tFta:
my 3, 2002 HRU
'el.' A l mac t�ONDIN
G OM. INC.
* * * * * * *
RADON C.C.F.
Fire
Zoning Buildin
Mechanical Plumbing,
ss#
Competency # 6 1 19 /
Address
Master Permit # e `//7
Phone eysti- f,2- - oC7t$
I na .Co. h r el S j y
Estimated Cost(value) 7293f//
Signat
Date:
(r'
s o Contracto �pr O NrY' ._ t
ssion Expire .., ` # CC 739018
k , s Fsm res May 3, 2002
BONDED IHRU
P .1.'1 NNfir ccr1NOIt40 CO.. INC.
* * * * / *. **
* *
V �
174 NOTARY TOTAL DUE 3 �° `/
Other
Electrical
Engineering
/lddrne
KI ' • WIMIW TITIN: • 7bst'e1oNa.
stl Mond No. NOT1Ct OF OMMOVICMEDIT P P �
STATE of FLORIDA y Jartca t •
Q`' THE UNOER$$GNEO hereby Alves notice het be mile Is Mein red mossy,
<I and M accordance WI Chaplet 713, Florida StdiMM MM IOMo4 0 Woman k proMdld In Ills
0 Nora o1 Commencement. •
IQ 1. OadOlen of property Omd desatpbn of propel% and ONO WOW ft atrwbis)
IQ Lai -30 Block
�' Street address: a U ri, • 't • , m I. 5 t-, 333/3 br
,. 2. General deaoripson o1 improvement:
installation of interlocking
brick pavers
3. Property Owner Name: C
a. Mailing Address:
an oath, tNs 7& day of
Signature of Notary
Printed Name of No
SEAL
■v.
•
b. interest in property: n ( to
c. Name and address of fee simple titleholder (If other than owner):
ovpi Jeffrey C. Abbott
i ,�, n +M CommissioCC 739016
Expires May 3, 2002
BONDEDTHRU — •
Of •• ATLANTIC BONDING CO.. INC.
oger1
•
L
3
a. Name and address: U.S. Brick, Inc. 941 N. St. Rd. 7, Plantation,F1. 33317 Contractor:
2 -3632
b. Phone number: 954 Fax number (opronai. M sot** try fax is seceptsble):
5. If Surety Bond:
a. Name and address: N /A
b. Amount of bond S
c. Phone number.
6. Lender:
a. Name and address: N/A
b. Phone number. Fax number (optional. a *entice by fax is acceptable):
7. Persona within the State of Florida designated by Owner upon whom notion orother documents may be served as provided by Section 713 .13(1)
Florida Statutes: N / A
a. Name and address:
b. Phone number: Fax number (c;:onal. t1 service by fax is acceptable):
8. In addition to himself. Owner designated the following persons) to receive a copy of the lienor's Notice as provided in Section 713.13(1)(b). F.S
a. Name: Dr /I
b. Address:
c. Phone number'
d. Fax number (optional. if service by fax is acceptable) :
9. Expiration date of notice of commencement (the expiration
date is 1 year from the date of recording unless a
different date is sped
Signature of Owner
Owner's Name — �.����� • �• �`
Owner's Address
Signature of Owner
Owner's Name
Owner's Address
Sworn to and subsabad before ms by
who Is personally Ivey/nit) the or produced
as • tillcaaon, and who did _ Niw
if v/li- ' 19
'9
Fax number (optional, if service by fax is acceptable):
'P
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