261 NE 97 St (6)// PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / 6� e / / J ob Address 1 / f 6 / 7 Tax Folio
Legal Description 1-0779 • OF, 7a Oil, t , 3 1 Historically Designated: Yes No
O / Tenant 7 & 5 , i /i E i F & � . /a Master Permit # 54 l C c
Owner's Address v / 4 g7 677 . Phone 3 9 / 41/ 6
17 l //' !� // 7 ��� l/ L
Cantractin Co. � � - 1 / � �d���.E? l� or- �l Address ? 59(
Qualifier 3i/! SS # Phone 3 5 . 050-
State # 6
Square Ft.
Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company - Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVN FENCE SIGN
WORK DESCRIPTION J tG h7P d �'� (� �..N / oli'i v_42 Le/a 6n Ci p r c
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 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.
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.
S
Notary =s • and/or Condo Presi
My Cornmissio i ' xpires:
FEES: PERMIT I RADON
Estimated Cost (value)
C.C.F. / - NOTARY
g/ "2d
Signature of tractor or Date
Notary as to Con
My Commissio
BOND
APPROVED: TOTAL DUE
Zoning Building i 1 i ^''"' r l Electrical
Mechanical Plumbing Structural Engineer
NOTICE OF COMMENCEMENT
A RUORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements 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. Legal description of property and street address: %/ /� / �. QS /-/
1 17 Iv, /z of L2-0 6 3 j 4mi 4 lel 4 /-65,
Pl'
2. Description of i rovement:I
(2-11' roa
3. Owner(s) name and a ress: D F) (...�./z..z. ` 0/ 2 D / ,1,/ 97 5
Interest in property: 0 (IJhJ2- h
Name and address of fee simple titleholder:
4. Contractor's name and address: /1 h5 e dDi)6 e /= P /,
199/ 9 67- » 2 , J t /, 3 3/6g
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or othe 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)
Signature of ner
Print Owners Name Jee
Sworn to and subscribe
Notary Public
Print Nctarv's Name
My Cc:-:m ss on Expires:
V
Pif1Z4s'� c'1 I V t`
99R489937 1999 SEP 22 12:30
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