240 NE 99 St (2)Contractor
or Builder
Legal
Description
Address Address of
Building
BUILDING
- ELECTRICAL
`� PLUMBING
ROOFING
MECH
MECH
Cl Owner of t
*Building
S o f
Architect
•
MIAMI SHORES VILLAGE, FLORIDA
305 - 795 -2204
PERMIT u 4a
Date
Contractor's
License No.
— `N:
20
PERMIT CARD MUST BE AVAILABLE FOR ALL INSPECTIONS ( � ,
Work to be performed under this Permit / t ld�P? 1 • > l \, i .
fit
,a
i.:o� ,f, { I t N
J ti II Bi ' Sq. Ft.
O_J,
Value of
.s%
FOOD. r
■
° 3 Permit: E d S/ 0 0
RO p
b - yy �� }}I 3
Sabdi- 3 Notary: 0
o `vision ot- P RI)
5 l
Bond: jf7i�
- , C
Radon:
Amount of u� f
Permit: Li �, (ti C\
�✓ CJ L a, t v
� _ -
This permit is granted to the contractor or builder na above to(con3tf the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto' and n any
th the understanding that the work will be performed in compliance with an
plans, drawings, statements or specifications that may have been submitted So and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinancesior if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or buildef ndined above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shq(rn op plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or _enfloyeess7;'
igned , r' "°' "i r — ' (INSPECTOR) BY
In consideratioy,00f the iscpa . e to me of this p i it I agree 'toperform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto agdiin strict,co ormt with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting his pd` it i1 ssum" respo ibility for all work done by either, myself, my agent, servant or employee.
J CONTRACTOR or BUILDER BY AUTHORITY
Miami Shores Village
Building and Zoning Department
Miami Shores, F1 33138
RE: Property located at (address and legal description)
2 /o JJ4 99 s-R E1
Gentlemen:
As legal owner of subject property, I request the cancellation of permit number 4 796 issued
to //ea rf4.s'/v.i e Co,s /vac li an , for the following reason: Veq a Ei rd 5
�I L.i_.t•t c. DA PJ Ii4e P 1 c&� Fa i t, f 4
so ) P3 tzea c++ v F
n tic napt.; •
Date of last inspection: !' a s - o /
I hereby apply as owner- builder, or authorize (new contractor)
to apply for such permits as necessary to construct or complete the construction on subject property.
I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them
from any responsibility or liability for any legal action or damage, cost or expense (including
attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit.
I furthermore assume responsibility for the correction, if required, of work performed under the
permit for which I am requesting cancellation.
Very truly yours,
(own
(print name)
s signature)
sro, 60,0Z*t - &Z
comic -A-c T
HOLD HARMLESS
(signature)
Date Z /2, 7-1)
Prime contractor (only if
subcontractor holds permit or if
change of qualifier).
(print name)
STATE OF FLORIDA
COUNTY OF DADE:
The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the
above property.
Sworn to and subscribed before me this
Notary Public, State of Florida at Large
day of
)
Ar!( pia M
comm,......;