145 NE 98 St�l-
Contracting Co. Pli- . 5-41
Qualifier 'AAA (ems 9Z
WORK DESCRIPTION
N.tary as to Own. and/or Condo Pres
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date GH C Job Address t Lk s )J e 1 0 k Tax Folio
Legal Description /LAW A ea 1 5 ' 'e 1O j S S C 1 Historically Designated: Yes �N`o
Owncr/Inessee / Tet t IV--4 Q./1 ' v A 0\ Master Permit # `7 c "/ g 7
Owner's Address / ((•r Ne.; 5 re
State # Ef 90V° G2 Municipal # Competency # Ins. Co.
Architect/Enginecr Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
�t> 2 Lay it'i-- A,eu4 1/ cam- L4
r s= ✓t�� s
Square Ft. Estimated Cost (value) 9 -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 the work stated.
Signature of owner and/or Condo President Date
FEES: PERMIT 5J/ G °® RADON
Pc C.
R ,✓J Sa Ss# `/ Phone ( � D � ) 3 79
OFFICIAL NOTARY SEA
XIMENA FERNANDEZ
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC3n483
MY COMMISSION EXP. :TAN. 12,2003
Signature of Contractor or Owner - Builder
u
Ndtary as r �to Co or or Owner-Builder
My Commission Expires:
C.C.F. - I,Q 0 NOTARY
i t 3149 O - 2, 3/1
Phone
Address . 3*, 0 )c-t) 7, > -v. N Q �r
OFFICIAL NOTARY SEA
XIMENA FERNANDEZ
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC801483
MY COMMISSION EXP. AN. 122003
TOTAL DUE
Date
Date
APPROVED:
Zoning Building Electrical ) - •
Zo g
Mechanical Plumbing Engineering