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27 NE 94 St (8)Miami Shores Village Building Department ` 11 1 Q(o 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 aster Permit No. BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Owner's Name (Fee Simple Titleholde Owner's Address 2.1 U City $. L 4.f. -1 ` '10(1 -t� State "i"L Zip Tenant/Lessee Name Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Contractor's Address City Qualifier Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Type of Work: Describe Work: ❑Addition ❑Alteration .A 1.v l Total Fee Now Due $ W ' S� (Continued on opposite side) ,v1 Electrical Plumbing L l ,Tt County Miami -Dade NO Ph one # Contractor's Company Name \ 1.0 • Phone # State Certificate or Registration No. Certificate of Competency No. ❑New Code Enforcement $ Structural Plan Review. $ Square Footage Of Work: * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Notary $ Training/Education Fee $ 1 00 Scanning $ Radon $ Zoning Permit No. 4- 1 1 Phone # Mechanical Roofing Phone # 7G' — 230 — 3 r n 56)-- - 7 - - 7 Z� Zip State Zip ❑ Repair/Replace ❑ Demolition CCF $3. 00 ' CO /CC Technology Fee $ . Bond $ • r l ■ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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 construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent Contractor *'he foregoing i strument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 (AP, by i j,/ S /� S , day of , 20 _, by v ' who is persona 1y known to me or who has produced who is personally known to me or who has produced , D /L As identification and who did take an oath. as identification and who did take an oath. NOTARY P `j� NOTARY PUBLIC: Sign: ` ji� Sign: Print: 4 /Chi 00 Print: My Commission Expires:' 6 i 2 -O 6 6 *****************r a �•N, MO6 . ( O 6 Plans Examiner Engineer , C �U � Zoning ,,, ,,,, Atlantk BandingCujiic. APPLICATION APPROVED BY: chc 05/13/03 My Commission Expires: Miami Shores Village Paint Color Approval and Agreement Date 2 /(LOIOl0 ' /) K1f � > - L S'iTth Phone # Owner's Name I�-� 1 O wner's 'f Address . 2- - 1 S T City I 11 t S'1C State F Zip 3 & l -4 2) Job Address (where the work is being done) A+ `i'e City Miami Shores Village County Miami -Dade is Building Historically Designated YES NO X. Contractor's Company Name (if applicable) Phone # ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All elements on the site must be listed and indicate the color to be painted Walls S kE -t /.)I n k )1 i l i rimS C_ OU 13 ' cz_uo ►J tA) l t I Lett -k 1* Fascia Drip Cap /drip Edge Soffit Roof �'►'f1�T`�SVIR- 1Jl�l 11c LY L - Flower bins Awnings Chimney Doors and door jams Garage doors 1.51 t4 Railings Fences Signature APPLICATION APPROVED BY: Owner o Ag t P& Z Official Zip Sv3'\ ■a Attach Color Samples With Numbers Date l Date Decorative metal All brick (simulated or regular) Stucco banding rIciti• 71 1 Any other stucco features Accessory Buildings Other ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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 construction and zoning. ( the 6/18/03 Located at: By Produced VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE .STATEMENT being the legal property owner, for the property Was aclrnowledged before me this ! -- day of Legally described as J ni -E Do hereby petition the Village of Miami Shores to d understand the following for pursu disc lo to the laws of the State of Florida, F.S. 489.103(7),And I have read an Statement, which entitles me td a ork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied l fo your permit contractor an exemption to that law. The exemption allows you, as the owner of your property, to d or even though you do not have a license. You must supervise the construction yourself. Yo may build a improve a one - family or two- family residence or a farm out - building. You may r commercial building or sal e e le or cost of S25,000.00 lease. If yo u less. The building must a building you have built yourself within one year after the may not be built for or If you s construction is completed, the law will presume that you built it for sale or lease, which is a violation of this sure exemption. You may not hire an unlicensed re b}rst state and by o county orsmunictpal Licensing that people employed by you have 11 q ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A. and with- holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes and zoning regulations. Proof of ownership provided ( ) initial of reviewing clerk. The foregoing instrument 3: 20.34 S who is personally known to me or who has • as identification and who did take an oath: " ".Richard Ojeda Pd !i %Comm •W1 =� :a fi '� 9 % Atlantic BozidiagGa.ne. Inspection Date: 07/10/2006 Inspector: Grande, Claudio Owner: SANTOS, MARCOS AND LEAH Job Address: 27 94 Street NE Miami Shores Village, FL Project: <NONE> Contractor: HOME OWNER Building Department Comments Thursday, July 6, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I I Block: Permit Type: Paint Inspection Type: Final Work Classification: Miscellaneous ■ Phone Number (305)759 -8255 Parcel Number 1132060130540 Lot: Page 2 of 2 . ir Passed o Inspector Comments Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Inspection Date: 07/10/2006 Inspector: Grande, Claudio Owner: SANTOS, MARCOS AND LEAH Job Address: 27 94 Street NE Miami Shores Village, FL Project: <NONE> Contractor: HOME OWNER Building Department Comments Thursday, July 6, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I I Block: Permit Type: Paint Inspection Type: Final Work Classification: Miscellaneous ■ Phone Number (305)759 -8255 Parcel Number 1132060130540 Lot: Page 2 of 2 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 I Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Issue Date: 2/17/2006 Expires: 02/16/2007 Owner's Name: MARCOS AND LEAH SANTOS Permit Type: Paint Work Classification: Miscellaneous Job Address: 27 94 Street NE Miami Shores Village, FL Miami Shores Village Contractor(s) Phone Primary Contractor HOME OWNER Yes Comments: EXTERIOR PAINTING Additional Information Type of Work: Exterior Color: RELAXED KHAKI, SUPERIOR BRONZE Additional Info: Classification: Residential In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL 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. Futhermore, I authorize the above -named contractor to do the work stated. Building Department File Copy Applicant Signature Parcel #: Block: Section: Permit Status: APPROVED Permit Number: PT- 2- 06-411 Phone: (305)759 -8255 1132060130540 Lot: PB: Total Square Feet: 0 Total Valuation: $ 5,000.00 Required Inspections Final Fees Due CCF Education Surcharge Permit Fee Technology Fee Total: Amount $3.00 $1.00 $60.00 $1.50 $65.50 Invoice Number PT - 2 - 06 - 23862 Total: Amt Due $65.50 Amt Paid $65.50 $65.50 NOTICE: In addition to' the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Owner Date - • Legal Descriptioe Owner's Address Contracting Co. Qualifier j State # Municipal # Competency # Ins. Co. I Architect/Engineer , Address Bonding Company Address Mortgagor a. cgG,,,1//'U fan 4Ie Address Permit Type (circle one): BU H,DING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Square Ft. i(ro Estimated Cost (value) 3 r5 d7 WORK DESCRIPTION 114 / 14 -"it 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 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 construction and zoning. Furthermore, I authorize the above -named contractor to do th work stated. 4 use C'c ""fit/r) P as-/0a ,4- Signatures caner and/or Condo President Date,., Signature of Contractor or I er- Builder • Notary . s to Owner an '∎ •• r Con ' ttiant J VILLtR Date My • mmission Expires NOTARY PUBLIC STATE OF FLORIDA LY COMMISSION EXP. MAR COMMISSION NO. CC714103 MY COMMISSION EXP. MAR.1 FEES: PERMIT RADON APPROVED: Zoning Building Mechanical Plumbing PERMIT APPLICATION FOR MIAMI SHORES VILLAGE (.011 55 Tax Folio Historically Designated: Yes No C.C.F. Address Phone , L / 9 6 8 ' 7,f - 7 Y 5 6,? / Notary as to- Contractor or Owner - Builder /My mrmssion Expires: NOTARY Electrical Master Permit # 2 9� Date Date Structural Engineer sic MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: \c' // �- �� 0 0 o OWNER'S !NAME: iii „L�_ / J � , PHONE: J I q7 b ADDRESS * 9- N S 7 ' ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ADDRESS OF SITE: Sa a 6 CONTRACTOR & LICENSE (f p lic�b1e) COMPANY NAME: I ' �` a PHONE: All Elements on the site must be listed and indicate the color to be painted. Walls Fascia Soffit Roof Flower Bins Shutters Awnings Chimney Doors and door jams Garage Doors (j(. Railings Fences Decorative Metal All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings Other Building Official Date 0 0 4 ,cn _J n H H 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 construction and zoning. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. Signature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED: WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION Date 7 /! x Of Job Address o / F y Tax Folio I 1 o� (D 6 n(3 0 5 T 0 Legal Description 130,-/() Pik Historically Designated: Yes No Owner/Lessee / Tenant tq'i°PdA il)/ Master Permit # 1 / 193 9 Owner's Address .2 ') M_ / / Sr Phone 3 0 S^ L i g (` L/5 Lj L/ Contracting Co. Address Qualifier 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 PtY I� Square Ft. Estimated Cost (value) ( D ) "0(9 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 laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. ssion E e of owner and/or Condo President Date ' l ' 0 130 -y3. . s- - - O 1A 1) . _i _O� At ' ► _ ; 1 , 7 as ' S er :it • or •n. o • My Co FEES: PERMIT h 0,0 0 RADON APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE esident y PU B ANGELA I:, L3ECKEfd ` �o COGIL1151 On '!LJ 3FF Q Cc7a6697 -37's OF FvOC\o M NOV, :ISSION E U, ES Date Signature of Contractor or Owner - Builder Notary as to Contractor or Owner - Builder Date My Commission Expires: (,) NOTARY j „ a 0 BOND TOTAL DUE(( h (� Date Zoning U`' " "-- Building Electrical Mechanical Plumbing Structural Engineer MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: - 7/ ` / l OWNER'S NAME: (t1tovo, `4)a p a , -nr, j PHONE: c ) 48(4 4 4 . ADDRESS: 23- V-67 91 s ' ! cae*4cxseac ********%k*X*>; * ** *****X********** **** ** *** ******* *****?: *** ADDRESS OF SITE: SA A-SO cJ CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ***************!***************** * * * * * * * * * * * * * * ** * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls 1 - 1 1 (2 fi Fascia 1 -- 110 2 - Drip Cap/Drip Edge (,(,/ii / (� Soffit Roof Flower Bins ( — 1( 0 Z f Shutters Awnings Chimney Doors and door jams 1-- I (0? Garage Doors &i1-, k. Railings Fences --- Decorative Metal U/ / �P All brick (simulated or regular) Stucco Banding / —// © 2 F Any other stucco features Accessory Buildings Other APPROVED: 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 construction and zoning. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION A • Signature o Owne ' Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Y1/4a/e/ Building Offici Date 2 „ J 4/23/01 MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: 7i/10/ OWNER'S NAME: /cep, c; Pq �O �c, 1' PHONE: ADDRESS: 2 7 NE - y ************************************ * * * * * * * ** * * * * * * * * * * * * * * * * * * * *•. ADDRESS OF SITE: 3 v� CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls Fascia Drip Cap/Drip.Edge Wt/t -t* Soffit Roof Flower Bins r Gk a�� Shutters Awnings Chimney -� Doors and door jams (it' h r P Garage Doors Railings Fences wtirsie Decorative Metal n ‘ (v All brick (simulated or regular) Stucco Banding Any other stucco features Accessory Buildings r Other 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 construction and zoning. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as,per the attached sampl APPROVED: 7A/CY Building Official Date 1 .4ct R.21 Cls- -^ 0 r 0 F ICJa. o (/ 6►'� S ignature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 0 Job Address g7 71‘ Tax Folio I:4°6 /3 a ` C" Legal Description/5 '/ 7 ;L cledi Notary as to Owner and /or Condo President My Commission Expires: Owner / Lessee / Tenant �/ � %',rpt f AbfAii.•J Maste Permit # '/ Owner's Address \A fgr Phone 16 .` teontracting Co. 4j444I1 Qualifier SS# - - State IP Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECT RICAL i / PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN vORR DESCRIPTION d U , C "e 1!) ; ( f� - /ei bo ( e---- Square Ft. Estimated Cost(value K g v Address Phone 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 w.rk will be done in compliance with all applicable laws regulating constructio _ : zoning. Furt I authorize the above -named contractor to do the work stated. / II � � L / , , &� (be-W/0 Signature of owner and /or Condo President Signat e f Contractor or Owner- Builder Date: Date: 5 // My Commission Expires: I li protar as to Contractor or Owner- Builder ** * * * * * * * * * * * // * * * * ** FEES: PERMIT , �. D RADON C.C.F. 6 --A° NOTARY ;7 � TOTAL DUE t/ / d APPROVED: Fire Other Zonin_ �uildi � Electrical Mechanical 'lumbing Engineering PERMIT APPLICATION FOR MIAMI SHORES VILL Date Job Address /V / 7 4U , E , ryJ Tax Folio Legal Description Historically Designated: Yes �/� Y� - I 7 4 Owner/Lessee / Tenant Q I C, I �/�.. l ^) a) n Master Permit # , Owner's Address ( / is-75 ' ' ` dmA4 m:33/ie Phone 3 J -- a / C o n t r a c t i n g Co. Nv-J•( V - Address 0.Y. 3Y IN SPEC - TOR Queer SS# - Phone State # Architect/Enginee T/ Bonding Compan Address 7/ 0 - ¶ _ 1 /B 1324 A ddress 4-_,72- f /40 1 if\ `Tr : � Mortgagor 13 0 l �/ "e 9 AA 4 0) ( al- 7 «- �•�, Permit Type (circle one): BUILDING ELECTRICAL P UMB ECHANICAL ROOFING P YIN NCB 'SIGN WORK DESCRIPTION � ' ..- ° , ✓ 1 Square-Ft. WARNING 2/E RESULT IN CONSULT Application certify that a permits are re OWNER'S A d/E 1327 e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin ermore, I authorize the above -named contractor to do the work stated. Signature of c Notary as to My Commissi FEES: PE APPROVED: Zoning — Mechanical o< 1 Address Estimated Cost (value) ✓S Gd 1326 RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY I IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, --LN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) nit to do work and installation as indicated above, and on the attached addendum (if applicable). I eet the standards of all laws regulating construction in this jurisdiction. I understand that separate ( 4BING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. Benjamin Moore Paints Date Competency # Ins. Co. (I 0.1y c( ✓ �,� Date Signature of Contractor or 9 er- Builder Date Plumbing 'Notary as to Contractor or O - My Commis . ,!- ypilv o AL I M= C 9 277 DEC. 17,2002 dz 0 C.C.F. / . NOTARY Electrical theellierazo BOND TOTAL DUE 4/4 6 Engineering PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3 .99 Job Address C 7 / / S Tax Folio Legal Description JJ Historically Designated: Yes No � Owner/Lessee /Tenant ra TC ( '4 �l(9 w/�J ` Master Permit# Y�V 'b J Owner's Address a- 7 ill/ 2 /11r Q r - �"/ �3/ 1' Phone - j 'U 7S S /S i Contracting Co. C' / c' d Address Qualifier SS# - Phone State # Municipal # Competency # Ins. Co. Address Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION -e85 44 G �h6,o k0, 1 I' (r)n G c (7- o v s-e_ O d vt Y � da 444 c ( -t)00 Square Ft. a C fo / l ((-- ' stimated Cost value 4 r l 0X7 I E 0 C WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT Y UR AILURE 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 required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. • e P o • i s 4 ' s icable laws regulating Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON C.C.F. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and th construction and zoning. Furthermore, I authorize the above -named contractor to ture of 7 C s ctor or rr 7 • er- uil i ;" 1 Tres: GLADYS) VILLAR NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MYCOMMISSION EXP. MAR. 1 No to on My Commission E NOTARY will be ted. gr da _,a Date BOND APPROVED: Zoning Building Mechanical Plumbing Structural Engineer Electrical TOTAL DUE