1165 NE 100 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Job Address // � / 5 7) 57— Tax Folio
Legal Description ,�i� Historically Designated: Yes No
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Owner/Lessee / Tenant �"0 / '/4�P Master Permit # 1 1 2
Owner's Address //65-441- / ) 57 Phone
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Contracting Co./ /f E0 lt y(� 6 �i 5°/✓/Zy L7 ' Address /a7 T /'` M714 /� ~� .S,o,2 / S
Qualifier /G/ =/f') T - W44e 6- SS# Phone 10S i& 2 /
State # Municipal # 3 `/ q Competeng # 3 ( Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN p
WORK DESCRIPTION /1 eMo v fit �l�d 5-7f f's /1°`) Z 5/13'i":"4
Square Ft. Estimated Cost (value) so, ca
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
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
RADON
Signatuq of Contractor or Owner - Builder Date
Notary as to Contractor or Owner - Builder
My Commission Expires:
C.C.F. NOTARY Ike BOND
Date
APPROVED:
Zoning Building ' * / Electrical
Mechanical Plumbing Engineering