260 NE 95 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date S4k Job Address 2 D'V S ,5r Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee /Tenant n �-z�/c1 P-: / � � C / ( Master Permit # Q7
/1V // .s
Owner's Address / ‘/g / �� /� t/ ).s
Contracting Co. avia Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING
WO DESCRIPTION
OWNER'S AFFI
laws regulating
Address
Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
lc.
2 7Wy,d-e7/?,7 1 71-e-yfrW
J
Square Ft. Estimated Cost (value) /0 n 0
Phone 90' Sb S o3
FENCE
SIGN
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.
VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
tion and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signat eof owner and/or Condo President Date Signature of Contractor or Owner - Builder Date
'Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires:
My Commission Expires:
FEES: PERMIT Z//1 RADON C.C.F. t' NOTARY - _ BOND
APPROVED:
Zoning Building /, Electrical
Mechanical Plumbing Engineering
TOTAL DUE
�� l
Date a /' 7 -1/ Job Addresa6n JI6f /`g_ v/ /A, Tax Folio // < .2 /3 3( e`
r
Legal Description 1J, J c .,F,4 ) /P� 7o o7/i/7'�j'a, /O, �j�5 /41- A4 -yS"
Owner / Lessee / Tenant / edit s ` / e. 4',1 0d/ Master Permit # 333;Y
Phone 737
Owner's Address a.260 fir 5;:5 /7 4
Contracting Co. /c' Address 1a
Qualifier SS# - 2 - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Addr
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 7iA// / - , , ,( //i097- e777 /'147
dirlD
Square Ft. Estimated Cost(value) 4 /l7 - 0 . --i
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
OWNER'S AFF _' T'
be done
author'
Date; of o r
/
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
for
ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
tha
1 a
r & '/ wd„e .. / z
Notary as to Owner and /or
My Commission Expires:
NOTARY PUBLIC STATE OF FLORIDA
** * M' COMMIS ION EXPIRES 5/09/a4
Bonded thru Stembler- Adams & Sect
FEES: PERMIT ,r` RADON
Condo
Zoning
Mechanical
11 the foregoing information is ur= e nd tha all work will
s regulating co w! r j on g�'u t -� •r , I
the wo state
esident
•gieo u e:IV 7 of "/
io 'quo iffaa1':Gia ❑
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❑'G•I pa'npoad 21O umou}j ' ggeuoSJkd
'ggnd LIC ON Io awru � els ao addi auiJd
Fire
Building
f hk/
to Contractor Owneg.Bil�der
ion Ex �/g'�o „ ;�a .� !�
Al. #$ype or stamp name of Notary Public
personally- known (]OR Produced I.D.D
1'y K. and number of I.D. produced:
* * * * **
1 D take an oath, or
[ DID N426te lath, / 9 M
Other
Electrical
Plumbing Engineering
a
/e t
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 5 /Zy /CD Job Address 260 /' � 117 S / Tax Folio
Legal Description Historically Designated: Yes
Owner/1 eso'e / Tenant _ (/ /[} 6144 / 5 Master Permit #
Owner's A d d r e s s ,2 b O 1 4 ' 1 l ( ( 54 Phone 30S/'7
No V
'1 ft 7
Contracting Co. () Address
Qturlifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
P e.0 Look A.4-
,Qe,io Vice (- L.tt & �✓- T?' /l/EG ,v / T� /� ��C
Cc) t/W s / 0 / ,Q e ��t' r' to "-1 a rch hou eD /or- -eks7- 11 I
Square Ft Estimated Cost (value) ��l7 • 1"
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.
OWNERS AFFIDAVIT: 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.
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Signature of Contractor or Owner - Builder Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Commission Expires:
FEES: PERMIT 3 D RADON C.C.E. Y D NOTARY ` " 0 BOND /
APPROVED: TOTAL DUE
Zoning Building ,v! / V4!o
Electrical
Mecharucal Plumbing Structural Engineer
JURAT
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r State of CA).1� r t a
County of
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8 Subscribed and sworn to (or affirmed) before me
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�
this �3r . day of 1al) ez coo, by
Date Month Year .,S
u Qg ( c�O� in
� Hn Vl SS2
.• �'• '` Name of Signer(s) g
ESTHER JINA KIM (2)
Commission # 1180058 Z
Notary Public - California Name of Signe ;s) C�
My Comm. Expires AP
San Diego County
Signature of Nota Public
1
OPTIONAL X
Though the information in this section is not required by law. it may prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document.
P
Description of Attached Document
I
P Title or Type of Document: �2�"fny -I r 1 Ca (3,, ' l fM
P Sher t � o.
Document Date: /.3 I aL Number of Pages: 1
Signer(s) Other Than Named Above:
P
F
RIGHT THUMBPRINT
OF SIGNER #1
Too of tnumb nere
RIGHT THUMBPRINT
OF SIGNER #2
Top of thumb nere
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1997 National Notary Association • 9350 De Soto Ave.. P.O. Box 2402 • Chatsworth. CA 91313.2402 • www.nationalnotary.org Prod. No. 5914 Reorder: Call Toll -Free 1- 800 -876 -6827