533 NE 92 St (4)Si
Square Ft.
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 57:...0 eC- / Tax Folio
Date ,,
Legal Description / "�'1 / d ` /
X' 7 /Wit / %OJ6r
Owner / Lessee / Tenant Av FJ iU 9/'
// Master Permit # 3 7
3 /U e. ! 2 cCie • Phor P.) C, '27
Owner's Address �r �t � /�
Contracting Co. s�� y 7a' G/7ilve, -Seg re;v b / Address
Qualifier SS# - ✓ - Phone/" P 7 i l 7 - 7 7P
State # ( Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING Q ELE E CTRICAL PLUMBING MECHANICAL ROOFI NG PAVING FENCE SIGN
WORK DESCRIPTION EK l /A' /U1' C W /) - kA4/7/� c`'/
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 complian
authorize
ve amed co
A
I certify that all the foregoing information is accurate and that all work will
all applicable laws regulating construction and zoning. Furthermore, I
rector to do the work stated.
6' 7
do President
ture o
Date: y-m
. F
Notary as tts Owner and /or Condo President
My Commission Expires: DEAltY
Notary Public, State of Florida
My comm. expires December 21, 1996
** * * * * * Comm. No. V247630 *
Bonded thru Brown R R- ,,, J).
FEES: PERMIT RADON C.C.F. 1
Zoning Buildin
Estimated Cost(valu j 7 /C/ -
D1
Signature of
Contractor or Owner- Builder
Date:
Notary as t ontractor or Owner- Builder
My Commission Expires: DEWEY E. LATTIN
Notary Public, State of Florida
My comm. expires December 21, 1996)
* * * eomm. N . CC247Ar30 **
Bonded thru Brown & Br
NOTARY TOTAL DUE
Mechanical Plumbing
Other
Electrical
Engineering
Permit No.
�rGeT�
r5 —�� I .
J /
J V. J2a
STATE OF
COUNTY OF: 0 Ai
NOTICE OF COMMENCEMENT
Y.
94R549674 1994 NOV 29 10:55
Tax Folio No.
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description of property: (legal description of property, and street address if available)
o 7 3 if? /tin / R/o d-/< of i7/i7 / /fe
2. General description of imp ovement:
tX7 i 6
3. Owner information: 5.33 -
a. Name and address:
1 p l /'C2 /t G Gl'A 4 ! 0 w lv • L /fir
b. Interest in property:
c. Name and address of fee simple titleholder (if other than owner):
4. Contractor: (name and address)
7 7c -P d / (�3
y Pv Q2_ r•e 5 - 74 . — Sears C o e (/,e - s�/7/9/527/3 - 1 e � , C &. /0441/ /
L
5. Surer
a. Name and address:
b. Amount of bond S
6. Lender: (name and address)
7. Persons 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 and address)
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes: (name and address)
9. Expiration date of notice of commencement (the expiration date is one year from the date of recording unless a different date
is specified)
Sworn to and subscribed before me
this `Bay of , 19 P>
(Signature Notary Public)
Notary's Name
Notary's Commission Expires
STATE OF FLORIDA
COUNTY OF
(Nance of officer taking acknowl
(Title or rank)
(Serial number, if any)
(Signature
Owner's N
DEWEY E. LATTIN
Notary Public, State of Florida Owner's Ad ress
My comm. expires December 21, 1996
Comm. No. CC247630
Bonded thru Brown & Brown,
ALL INFORMATION MUST BE TYPED OR PRINTED LEGIBLY TO COMPLY
WITH RECORDING REQUIREMENTS
The foregoing instrument was acknowledged before me this by who is personally
produced known to me or who has y
p as identification and who did (did not) take an oath..
(SEAL)
(Signature of person taking acknowledgment)
cdgment - typed, printed or stamped)
DA
DE COUNTY or ¢
Sq�Tt: of DLO OM* this is a Qvuo� dcv �9
gCsa�9q �D119�v
in Opifi;\>in Lig
b9
0 0t c iot Sad. ^qg ceoP
Dg�.�
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