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1130 NE 100 St (13)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date (i /Li/ Job Address'\ / / � j 1) /1q,' (00 £4-- Tax Folio Legal Description Historically Designated: Yes / Tenant Owner's Address Contracting COy 6 W n 6‘C 1/ SD `C" l /3D N,[� CUdit Qualifier SS# 2d Master Permit # q3 2. Address State # Municipal # . Corn; Architect/Engineer Addi Bonding Company Addres Mortgagor Addi __ _ Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL Square Ft. Estimated Cost (value) f _C/0 Phone k �O�l -' j / Da S N N SIGN ROOFING PAVING FENCE WORK DESCRIPTION X P c? i r� f— E 7)-1 dI f -`,�- r G-- (Pc (ac- 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. aj:Svt"-ItA ///199 Signature of owner and/or Condo President Date gnature o Contrac. • or Own - Builder � :�, C95 - © c� Notary as to Owner and/or Condo President Date Notary as : ' ontractor I • • , ate My Commission Expires: My Commission Expires r - NO '��� , S a►i SEAL AR ' 61.:A11YS'VICIAR % dFARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC714103 MY COMMISSION EXP. MAR. 1,2002 FEES: PERMIT RADON C.C.F. NOTARY Electrical BOND APPROVED: Zoning Building Mechanical Plumbing Structural Engineer TOTAL DUE