DRIVEWAYPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6 — 20' Job Address / gi6 A/Z 95" 5 Tax Folio
Legal Description 4/3 f /D 6 3 7 Historically Designated: Yes No
Owner/Lessee / Tenant rT i,&cwi< flA fl S Master Permit # 5
>2-
Owner's Address Sf,419 Phone 30.5.. Z. �3 ' 7
Contracting A Co. ,he /Y/"&a?.//y ,45C
Qualifier /)6¢,u/W i0�1 //t.J SS# , - Phone 305 7.5" 7 -7765
• State # ///,/ Municipal # a{',4e5 -y Competency # f /3S5 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHAANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /BA /G',e , 4a9r5) �e /0:3 �/i//�°CCP// ,4 iui4ei€r l/`.���, -4
Square Ft. 3; Estimated 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 PROPERTY OF 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 laws regulating
constru tion and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
signature of owner and/or Condo President )late
- d ` Z-) ■? 72 F )1-- /
d/or Condo President 1 to
7/9
Notary as to Own
My Commission E
FEES: PERMIT
APPROVED:
Zoning
OFFICIAL NOTARY S
` P nY PIA9 g IAAROARITA MO"'
I,, E 0 cowassON NUMBER
, 1 Q GeV CC N EXPIRES
OF F�O DEC. 17,2002
RADON
Mechanical Plumbing
6407
Building
X
•
•
• FR 671 s
GLADYS) VILIAR
NOTARY CMISSION NO. CC7 4
MY COMMISSION EXIT MAR. 1 . 002
S' of Contractor or 75ner-Buil
1
�,IZJ
N G 4 as to Contractor or Owner - Builder Date
tur
My Commission E
C.C.F. 7 NOTARY
Address _ 70 ///" "Aath:5 A/
Electrical
Structural Engineer 1/44 l )/ (99
/ -Fr-Co:3.3C ?24'
BOND 3,0
TOTAL DUE 3 t
e& /0%kJ -a . a
NC 1 E. OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRS INSPECTION
PERMIT NO. TAX FOLIO NO. / /-3 06 - £V 4'0 CO
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements wiA 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. Legal description of property and street address: /2 gS !V t, g 9...r St i
t T �t S4
, 31
/L✓ A Ske L
t➢ li. /o -37 z iv t illic g's
2. Description of improvement: 2-7;?; ,8/7 e e ",": ,Z) l?,)4 e GI'jrz 2, -- - 4� /
3. Owner(s) name and address: Vi (in k/ ( i4- r k f},e.2 /S
12- -- 6 N, E.. f.Siti - . in uchan l Sfrn -FS I Lf 31, "R 8
Interest in property: ) n) r/1.--S /�
Name and address of fee simple titleholder. rJ 0 2/Ct'' I � e. j 2l s
l ..� N . 9stitt %- _ i\(1 t 1141A i S tSlivAr.) 33
4. Contractor's name address: ,v e'GI', T/L E� T
.� � i _ ---5- AZ . /_ • ..t
e1 i` Lt 1 ' , OF FLORIDA,
COUNTY 0 DADE
S. Surety:(Payment bond required by owner from contractor, ffp m ac � lRE6V CERTIFY tho' this Is o true copy ► the
`� , Igina. fil od in this
Name and address: /v (TINS `� p > - a i a °li ce on s $ day „
-- A D 9
' y " ✓INESS my h, nd and Official Seel.
Kam" RY €i /WIN CLERK, ofC,r.v: u.1 CountyCooP.
6. Lender's 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 this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
mature of
Print Ow
•
i
.�.. - ` -41
! y
ers Name
Sworn to and subscribed before me this
Notary Public , A k
Ncta: :y e �•..
s Name C l (-i 1/4.J
R*2(zIs
C1 day cf c:(r
4 k ca
99 R560699 1999 NOV 02 13:41
Prepared by:
Address: , L714cre ; 4
`ccccciGtCC<CL .. . <cc�c •
j) 1 10 P ii Arthur H. Stonelake, Jr. )(
a ° Notary Public, State of Florida e�
a ` Commission No. CC 618327 k � 1'oFf'- °Q My Commission Exp. 3/21/2001 �( -