278 NE 97 St (10)APPROVED:
Date //1/q3 Job Address -% . 4 NE q '7 3%t •
T 1" Door S
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT 0 RADON
;!,
Zoning '.e
Mechanical Plumbing
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
••a A •II norm VILLAGE
PERMIT APPLICATION FOR MIAMI SHORES VILLAI
Date / - - OD Job Address N ( c+ Tax Folio
Legal Description Historically Designated: grated: Yes
Owner/Lessee / Tenant A f `U . � � `,� � Master Permit #
� r
Owner's Address 7 �. C 7 `-� (' +- Phone i°, " 7, %
Contracting Co. Oj Lf) �^� ` SOS= b ' ��l I(
Address
Lc; rk A Oil 5
Date
Structural Engineer
Phone
v �
C.C.F. c 6 0 NOTARY 3 BOND
TOTAL DUE
Qualifier SS#
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING I ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION �C4C -L ■ i CC
Square Ft. Estimated Cost (value) (00
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 mee: 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.
Signature of owner and/or Condo President Date
v -ctui2 7 - 6 rOd
Signature o ontractor or Owner- Builder Date
otary as to Contractor or Own 'I4tiiitfeila'r Date
My Conunission Expires: , j CO: s ri.I 4° :
FJL r3)- o•- of 3- 6 - 0
A) i /- l',cGP e //c PL
7k (co
Building Electrical
s �
BUILDING
ELECTRICAL
PLUMBING
><OOFING
Owner of
wilding
'architect
ontractor
-- )r Builder
.egal Lot
)escription
'address of
wilding
❑
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N? 5657
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $—
DATF
Contractor's
License No.
Amount of
I: Permit $
195
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
ierefor in strict compliance with all ordinances pertaining thereto and with the understanding thai the work will be performed in compliance with any plans
lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
!ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
, ertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work
one by his agents, servants or employees.
Signed- - BY
''
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
, ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY
6 a