301 NE 98 St (8)"gyp IT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
] /A Job Address ,.5:)1 a 5 t E % V Tax Folio ��-3,ZO�' -O��J _ (o
Lc vescription (UIoual 64ciegb � 1 aQ P 3 lo-/D Master Permit # PS.? 1 or
w /2 of LoT Idi 4 ►-psi" 6I. -91 D tEL lt2o,S∎VA.L0
/ Lessee / Tenant
Owner's Address
Square Ft.
g< 0
Contracting Co. 1•/ /f6 Address
Qualifier t1/41/4 SS# - - Phone ---
State# 19a Competencylfr Ins.Co. _
Architect /Engineer NI 4 Address
Bonding Company A A. Address
Mortgagor ..:11NARZ5 MortT2ILSOWL Addressee. 15, 71/01 D3
Permit Type (circle one): BUILDI ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION ' it.11' E:9
1757
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 • do the work stated.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President 4d� � �/
�ota� as t to Contractor of O,raner- Builder
y Commission Expires: 3f / /(p X
* * * * * * *
My Commission Expires:
* . *
PERMIT FEE: APPROVED:
Zoning
Mechanical
Fire
Building
Plumbing
nature(; Contractor or Owner - builder
Date:
Estimated Cost
Phone 7S1 1 I0
Electrical
45d
Engineering
*
*
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date q ZS 6 11 Job Address - 30 � n l s+ Tax Folio
Legal Description _ r Historically Designated: Yes No_
Owner/Lessee / Tenant J f i zGt' 6 S +cd - Master Permit #
Owner's Address 5 D(
Contracting Co. 6 ` • 1 /-( /=' fa Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circ ➢e one): BUILDING ]ELECTRICAL P UMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION (te CIA+ N 0 L S d +(('v1 V a UvI Wl Vet' O (, ) / OV c ki4 G�
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 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 re Latin: construction and zoning. Furthermore, I authorize the above-named or '• • = '-e work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Phone '7`' ( 2 6 Go
Signature of Contractor or Owner- Builder Date
. ?
1ETotary as to Contractor or Owner- Builder
My Commission,Expires:
u
Date
FEES: PERMIT � / d• RADON C.C.F. • e NOTARY 57.
BOND
TOTAL DUE Ce":,S
APPROVED:
Zoning Building / 17 + / Electrical
Mechanical Plumbing y Engineering