1145 NE 100 St (4)02/13/96 10:31 MSc) 001
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
,71.
Data ..2/ate Job Address // `/$ ,►/c 10 0 •oS`T TaN Folio
A
LegalDesa•iption Historically Designated: Yes No
Owner/I.cssce / Tenant L,•,vn A ,,.a —
Master Permit #
39`ox-c
Ownees Address // Si s" Phone os— 7S /— . GP/7
33X/
Contracting Co. S �wft c•+?� � 1s.�rr. Address /Jo.f / to ‘r•,.. Sim 2 ' Z , e Cva eM
Qualifier //e..
State # egfi D.1 _i 71 7 Municipal # Competency # Ins. Co.
Arclutect/Enginccr Address
Bonding Company / " ,t'..c) .fie Address
Mortgagr Address
• Permit Type (ctrcie one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION C.4_1°....4.4./ F p 09 A1.0
SS# .? 4/07 f/7
Square Ft / "C017 Estimated Cost (value) 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 indicaied above, and on the attached addendum Of applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. 1 understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS. POOLS, ROOFING and MLCI IANICAI. WORK.
OWNERS 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, t authorize the above • I emit' actor to • he work statcd.
Signature of owner and/or Condo President l)atc f Sigmt rc of Contractor o, Owner- Builder Date
Notary as to Owner elicitor Londe President Date '(tary as to Contractor or Owner - Builder Gn Date
/ V
My Commission Expires: My Commission F.xl,izes:
I , joY P 4/ 6 , OFFICIAL IL'OTAFIV SEAL
N } C 3r SANDRA Pa MOPdTIEL
CO{ a EISSIOP� NUE QEIR
CC401261
7 �F� Y CQ; .EXP.
FEES: PERMIT " 1 RADON C.C.F. NOTARY TO
APPROVED:
Zoning
Meoharneal
B3uildin Z ( 01°
R
Elec
Plumbing Engineering
AI. DUE Yie: