1235 NE 100 St (3)PERMIT APPLICATION. FOR MIAMI SHORES VILLAGE
Date (-1d-1 � � �� Job Address � � -Tax Folio// 32I '5 A/I DDS
Legal Description `7' � / ge2d.V/tzei_8 60,
Master Permit # 37�&J
Owner / Lessee / Tenant
Owner's Address /02 3.`j
Coa'tracting Co.
Qualifier
State # Ef 7 4946 0f
unicipal �� Competency # Ins.Co.
Architect /Engineer Addres
Bonding Company Address
Mortgagor . Address
Permit Type(circle one): BUILDINGCELECTRICAD PLUMBING MECHANICAL ROOFING PAVING FE CE SIGN
WORK DESCRIPTION
"�.
Signature
Date: /
Notary as
My Commiss
** *
FEES: PERMIT
APPROVED:
Phone 9 7'L.5 - [)2,
Square Pt. Estimated Cost(value) � /Q.,6
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 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 om.li•p ce with all applicable laws regulating construction and zoning. Furthermore, I
authorize e .bo e -named contractor to do the work state
of owner and /or Condo President
to Owner and /or Condo President
ion E pugC' , , :o raga r S,SkL
t . N CC./:.V,.IS.:■ON NUiiaER
* rt' t a i;C3 1iru *
if" 4714 O ei V CJ:19.1iISSIGN EXP
e Cj
Zoning
Mechanical
*
O
C.C.F. 1' NOTARY
Fire Other
Building
Address /-21222 (.t/.•
Phone 42/5 fiea
Signature o
Date:
ntractor or Owner- Builder
Notary as • - Contractor ,or -1 • • - :uilder
My Comm., ss. o'i'Expires• ..•..:.•.. 3_:.d.
Q1 / S4\ • . .. ': ..•i ;CA
•(7n ` 'G? ;.'/ c*.„:),„*, .lii ' **
OF i".•`) .. .. -=
TOTAL D UE 4 41-44c -
Electrical
4 it
Plumbing Engineering_