1234 NE 101 St (2)Date '' Job Address / E / S Tax Folio * 10Z I R Oat
Legal DescriptionL 3 �'''' O CA , , 6 I� Jo p as j /'`'� / Pc a 8
/ Lessee / Tenant.l..ro kee. [ j T2i er Master Permit #
Owner's Address / I:lry ii 65 /f J* Phone 7S'7 NPY
Contracting Co.aido A 4C P Address ,.Yt 4 7 ? c.
Qualifier,+ 460/* SS# 757 VeY3
State # Municipal # Competency # /89Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor/
Permit Type(circle one) l ELECTRICAL PLUMBING MECHANICAL ROOFING PAV G PENCA� SIGN
►� i�- 1 ' e - e.
WORK DESCRIPTION
eye') t
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Square Ft.
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
AIME&(/iii,110r ._Ji
A
Sig
Dat
Notary as to Owner and /or Condo President
My Commi NOTA Expires:
PUBLIC STATE OF FLORIDA
MY COMMISSION EXP SEPT.26,1994
BONDED THRU GENERAL INS. UN[I.
** * * * *
FEES: PERMIT RADON
APPRCVED:
Zoning
Condo President
Mechanical
Fire
Buildi
* * *
Plumbing
Address
Estimated Cost(value)
S gna e f ' ontractor or Owner- Builder
Date: 1 /4
liPeGac4:- (5
Notary as to Contractor or Owner- Builder
My Commission Expires:
NOTARY PUBLIC STATE OF FLORI
MY COMMISSION EXP SEPT.26,1994
BONDED THR *GENERAL * INS. UN.
* **
C.C.F. "AICW NOTARY TOTAL DUE 0
Other
Electrical
Engineering
PERMIT NO.
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description f property and street address: 4, / 3, 3 . / 4 /1 A 4,1 .4epiq e
2. Description of improvement:
0,0 l l , it c ,$
3. Owner(s) name and address: vale 74 44. 1 44 X
Interest in property: a(/ A
Name and address of fee simple titleholder:
4. Contractor's name and address: 1
•
X 7 /J1 767 . , ,
5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address: q �. -
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes, Name and address: �yce ' di. J. i/ j Reli ADA
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
s � - ,
j _ ri it%
9. Expiration date of this Notic of Com (the expiration date is 1 year from the date of recording unless a
--" '' 7,/
different date is specified)
Signature of Ow
Print Owne
Sworn to and subscribed before me this L day of
NOTICE OF COMMENCEMENT
Notary Public
Print Notary's Name PO h - /C.e 6i9/1/1. / /g
My Commission Expir� PUBLIC STATE OF FLO°IU
MY COMMISSION EXP SEPT.26,1994
BONDED THRU GENERAL INS. UND.
-- (iTtgr
STATE OF FLORIDA, COUNTY OF H of tho
I HEREBY Cte' TIFY thpt this is a true 9Qy
csrlginalfilelin 0 c on
, A. 0. 19
W.TNESS my hand a. d Of, dal 5001.
HARM RUVIN
TAX FOLIO NO. /1 61 342 "OS' 008 Va
19 .
biro
Prepared by:
Address:
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c.
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