351 NE 98 St (13)Date _ -01.0 - GI S Job Address 2 ,c I N F a 9 s Tax Folio //
Legal Description L04- I S + I ,A /
(wne Lessee / Tenant ,41 :14t 0.01 t7O xJ Master Permit # 4/ A7
Owner's Address 3 ,\ l\J C Qs 5f Phone
Contracting Co. k7 n. S L e., J - Y\\. t,1014Lt Address , iA t -rr 4 � et14' 3.t Yo i
Qualifier 5. Q , R ta. SS# Phone G G G - 00/ 3
State # C t3C Municipal # Competency # Ins.Co.
Architect /Engineer (4VA-1 M4 e eve —A, - , Address ! 3l?6.l' S, lJ i k% e 12• y
Bonding Company Address
Mortgagor Address
Permit Type(circle one):(BUILDING) ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION R, 4 R. v►n Q�w..^. ►n9 rn Pte - (
Square Ft. 'Z 0b 4 -
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 comp a with all applicable laws regulating construction and zoning. Furthermore, I
authorize e -named contractor to do the work state$.
ignatu e o off: end /or Condo President
D e: �►
WESL,E
Notary as to Owne' and /or Cond. Pre rent
My Commission Expires:
** * *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
FEES: PERMIT I 2.5 RADON 40 C . C . F. NOTARY TOTAL DUE , (
71{
Fire
Zoning Building
Mechanical Plumbing_
0o Gb
Estimated Cost(value) 6_
Notary � ►: Y - Builder •
My Comm_ s s i orM EXPiFIWR NGTON
NOTARY PUBLIC STA?Z OF FLORIDA
COMMISSION NO. CC237222
* * * COMM 10N EX 0L P. 20995 .' *
Owner- Builder
**
Other
Electrical
Engineering