1270 NE 98 St (4)DATE: V1 h3 2DNb
ADDRESS OF FILE REQUESTED:
INFORMATION REQUESTED:
FILE RETURNED TO: INITIAL P ,
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 - Fax; (305)756 -8972
PLEASE PRINT
TIME:
NAME OF PERSON REQUESTING FILE: Li ` 0
istk-ci i - 30k
PHONE #: YOUR ADDRESS: C rl D (CIE 2AU-C.
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I understand that all documents in this file are property of Miami Shores Village and
that NO documents may be removed from this file. You may get 4 complementary
copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not
including any blue prints. If blue prints are order please be aware that we are not
responsible for the quality of the printed documents.
wledged by: r T v -
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date 4//6/V Job Address /Z- `? D /U. 7 8,5"7 Tax Folio /f , 328 . E d "3 /D f
Legal Descriptionfl ( 4( 4 (- ! q 5 g Permit #
Owner / Lessee / Tenant � �¢ , 4 � 7L
Owner's Address /2_ 7 /1/7c ? S e r----
Contracting // C �� o. n p GU �' � Ci) L /SUS / GCJL Address
Qualifier f/C04 ?/� iNO SS# Phone
state# Ca C D 0 g 67 ,3,3 Competency# 3 y/
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION 5 ,a- /) S f y
4- / /e /7` /i /r//,J 1'!c /e.
Square Ft.
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.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* . *
PERMIT FEE: APPROVED:
lf '74
* * *
Fire
Zoning Building
/ 3 333 -v 2 ` v�
Estimated Cost
Phone 7 5 - 7 2 2
Ins. Co.
/,c)
gnature of Contracto
Date: 4` 7/9/
fl
Notary as t Co ractor
My Commission' Expires:
* * * *
Other
Electrical
Owner - Builder
G[.t
or o er- B04dp.r ....�__�
NOTARYpUBLIC SITE OF FLQOIDA
MY COMMISSION E MAY 2 4,1994
BONDED THRU GENERAL INS. UN :,
Mechanical `' � t O t i i YrYlviumbin Engineering
Architect
Contractor
or Builder
Legal
Description
Address of
Building
MIAMI SHORES VILLA
BUILDING
O�CAL
' PLUMBING 0
ROOFING
Owner of
Building
This permit is granted to the
herefor in strict compliance with all
drawings, statements or specification
time if the work is not done in coin
granted, is the understanding that
pertaining to the work covered
done by his agents, servants or amp
In' co
pertaining
In accepting
tion of the is
d in strict
it I assume
CONTRACTOR BUILDER
BUILD
ELECTRICAL
' PLUMBING
' ROOFING
Owner of
Bidding
Architect
Contractor
or wilder
Legal
Description *lac
Address of
Bui1 ing
This permit
herefor in strict co
drawings, statements of spec
dale if the work is not done in
granted is the understanding th
pertaining to the. work coed
done by his agents, serval or
oNrRACrort;
In consideration of tise i
pertaining th din strict
in accepting is p mit I' ass
El ILDER
BY AUTHOltirt